The information provided below is a continuation of the recent posting entitled ‘Advanced Directives’.

Some frequently asked questions regarding ‘Advance Directives’ also known as ‘Living Wills’.

1. Are there any restrictions on who can make an Advanced Directive?
   An Advanced Directive can only be made by those who are over the age of 18 and who retain full mental capacity – ie of sound mind.
2. How can a document direct medical staff as to how the patient wishes to be treated in the event of their incapacity?
   A mentally capable adult has the right to refuse any medical treatment (but never has the right to demand a particular treatment). This right to refuse treatment extends to a refusal made in advance.
3. Are there any limits on how an Advanced Directive can be used?
   There are some limits placed on what an Advanced Directive can be used for. These limits include;
   
   • The Advanced Directive cannot ask for anything that is illegal, and thus this  presently includes requests for assisting suicide [euthanasia].
   • It cannot be used to refuse food or drink by mouth.
   • It cannot be used to refuse basic nursing care, such as washing or bathing. 
   • The Advanced Directive also cannot be used to refuse measures solely designed to maintain the patient’s basic comfort needs, such as provision of pain relief medication.
4. Once the Advanced Directive has been made and signed what happens if I change my mind about the treatment I would wish to receive?
   The Advanced Directive can be revoked [cancelled] or modified at any time so long as the individual who made the directive retains the mental capacity.
5. What happens to the Advanced Directive if the individual later provides a Lasting Power of Attorney?
   If the Lasting Power of Attorney provides express authority to the Attorney to make decisions on the Personal Welfare of the donor then this will override and supersede the Advanced Directive.
6. Does the Advanced Directive have to be in writing?
   An Advanced Directive does not necessarily need to be in writing. However there are some forms of decision that must be recorded and witnessed in writing, including the requirement that decisions to refuse life-sustaining treatment must be in writing. Verbally provided instructions, to family members for example, can be valid but there remains a much greater risk that a verbal refusal of treatment would not be carried out.
7. What information or procedures must be followed to make the Advance Directive valid and therefore considered when I lose capacity?
   The Advanced Directive must be made in accordance with the requirements listed under the Mental Capacity Act 2005 in order for it to be valid. These requirements differ depending on the extent of the wishes to be included within the Directive.
8. Who should I make aware of the fact I have an Advanced Directive?
   It is considered best practice to make some people aware of the existence of an Advanced Directive that has been drawn up for you. This could mean discussing the existence of such a document, or set of wishes, with your GP so that a note can be held with your medical records. It is also considered helpful to make your close family and friends aware of the directive or set of decisions.