Living Wills or Advance Directives to Refuse Treatment

A Living Will or Advance Directive to Refuse Treatment is a written statement from you to your medical team that can specify if and when certain medical treatment should be withheld to allow death to occur.  It is a way of making sure everyone knows what treatments you don’t want to have if you’re unable to make your own decisions in the future.

The most common examples include:

• If your illness can’t be cured and after all possible treatment, you don’t want to be kept alive by being given fluids through a feeding tube or drip.
• You do not want to be given antibiotics for an infection if you are only expected to live for a few days,
• You do not want to be resuscitated if your heart stops

However a Living Will or Advance Directive to Refuse Treatment can’t include a request to have your life ended nor can it be used to refuse any basic care you might need to keep you comfortable. This includes warmth, shelter, food and fluids by mouth, and pain control.

In Northern Ireland, a Living Will or Advance Directive to Refuse Treatment is legally binding in common law. This means it must be followed by your health and social care team, as long as they know about it. A Living Will or Advance Directive to Refuse Treatment must meet certain criteria. For example:

• you are aged 18 or over
• you are able to understand what it means for you – mental capacity

Legal Requirements:

The law demands that a Living Will or Advance Directive to Refuse Treatment must be in writing, signed and witnessed where it refuses treatment to keep you alive, such as having your heart restarted or being put on a breathing machine. It must state exactly what treatment you want to refuse so that there is no ambiguity. It must also contain a statement such as:

‘I refuse this treatment even if my life is at risk as a result.’

Otherwise it is advisable to include the following:

• Your name, date of birth, address and any particular distinguishing features (for example, a birth mark, scar or tattoo in case you are unconscious or unable to communicate, and professionals need to identify you.)
• The name, address and phone number of your GP, and whether they have a copy of your Living Will or Advance Directive to Refuse Treatment.
• A statement saying that the Living Will or Advance Directive to Refuse Treatment should be used if you ever lack capacity to make decisions.
• A statement of which treatment or treatments are to be refused, and the circumstances when your decision would apply.
• The date your Living Will or Advance Directive to Refuse Treatment was created.

Remember to review your Living Will or Advance Directive to Refuse Treatment regularly. It’s important to do this so you know it is up-to-date and reflects your current wishes.  Speak to your doctor, solicitor and palliative care team as appropriate,

Finally a Living Will or Advance Directive to Refuse Treatment should not be confused with a

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) which is a written record of a decision not to treat someone with cardiopulmonary resuscitation (CPR) if they have a cardiac arrest. You may have already made a decision about not wanting to be resuscitated in a specific situation and included this in your Living Will or Advance Directive. However, if you haven’t made a decision about CPR and you want to, you should discuss this with your medical team

After a decision has been made a senior doctor who is responsible for your care will make, write and sign the DNACPR.  The decision will be clearly written in your medical notes. You may wish to keep a copy at home. This is so that emergency services will know about it.  Your decision about CPR won’t affect any other care or treatment you have. You can change your mind at any time but make sure this is recorded in your medical notes.  Remember to also tell your family or the person looking after you  to avoid any confusion.

If you like to make a Living Will or Advance Directive to Refuse Treatment contact our Elder Law specialist solicitors on 02830267134 or law@lukecurran.co.uk for a free no obligation consultation.