Your advance care plan
An advance care plan is different to a will. It’s a way to tell others what’s important to you and how you would like to be cared for if you’re unable to tell them yourself.
At all times your current wishes and decisions about care and treatment overrule any previous documents or decisions. But considering, discussing, deciding and documenting your current wishes is very helpful to make the best decision for those times when you can’t say so yourself.
Best interests: The 2005 Mental Capacity Act outlines the process of how to make ‘best interests’ decisions about your care and treatment if you lack the capacity to decide or are unable to say yourself.
Working out what is in your ‘best interests’ means taking into account:
- the views of your family, key professional carers and other people you have chosen to act for you
- any information about what your views might have been about the issue at hand, including your earlier advance care planning
Your advance care planning may include one or more of the following:
The next three terms (advance statement, advance decision to refuse treatment and lasting power of attorney) are used in England and Wales. In Scotland and Northern Ireland, advance decisions are governed by common law. In Scotland, the equivalent of an LPA is a continuing power of attorney, and in Northern Ireland an enduring power of attorney.
- an advance statement: This is a way for you to write down and tell those who are important to you, including health and social care teams, what you know about your illness, and what is important to you about your care and treatment.
It can be used to share your wishes and thoughts, as well as help make ‘best interests’ decisions on your behalf in the future if you are unable say so yourself. Talk to your doctor or nurse and ask for examples of documents that you can use.
- an advance decision to refuse treatment (ADRT): This is a document where you write down in advance your decisions about any treatments you wish to refuse in the future. For example, you may not want to be given antibiotics for an infection if you are only expected to live for a few days. Or if you are being fed through a tube or drip, you may not want this to continue if your condition got worse. An ADRT is only used if you can’t express your wishes yourself and only for decisions about treatments that you describe in the document.
It is helpful for those who are important to you, including health and social care teams, in order to make the ‘best interests’ decisions on your behalf in the future (if you are unable to say so yourself at the time). Your ADRT must comply with the legal specifications for ADRTs outlined in the 2005 Mental Capacity Act. Talk to your doctor or nurse and ask for examples of documents that you can use.
- a lasting power of attorney (LPA): This enables you to give another person the right to make decisions on your behalf. There are two types of LPA:
- property and financial affairs. With your permission, it can be used as soon as it is registered. The person you nominate will need to show the document, stamped ‘validated’ on each page, when they act on your behalf.
- health and welfare. It only comes into force if you lose the ability to tell those who are important to you your preferences and wishes. Anything done under the authority of the LPA must be in your ‘best interests’.
You have to be over 18 to make an LPA. There are special rules about appointing someone as your LPA, and you must complete and register the forms with the Office of the Public Guardian. You can create an LPA online. It takes up to 10 weeks to register an LPA.
- do not attempt cardiopulmonary resuscitation (DNACPR): If your heart stops, what decision should be made about trying to restart it? Talk to your doctor or nurse about what this means and ask for examples of documents that are used.
- practical issues such as your will or plans you have for your funeral: Your will is usually made through your solicitor, who can also help with completing and registering your LPA. Some people also decide to spend time planning their funeral, such as the music and readings they want to be included. You can see more information about this on the following page. The term ‘living will’ doesn’t have a legal meaning, and can be used to refer to either an advance statement or an advance decision.
The term ‘living will’ doesn’t have a legal meaning, and can be used to refer to either an advance statement or an advance decision.
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