Advance directives are growing in popularity because they offer a way for individuals to keep personal autonomy at the end of life, and to maintain some degree of choice and control.

WHAT IS IT?

Sometimes called a ‘Living Will’, the advance directive form expresses your wishes to your doctor in the event of there being no reasonable prospect of your recovery from serious illness expected to cause you severe distress or to render you incapable of rational existence.

WHAT IT DOES

It does not ask the doctor to do anything against the law. All it says is that, under certain circumstances, you do not want your life prolonged by medical treatment, but you do want to be kept comfortable with pain relief, even at the cost of shortening life. In common law, competent adults all have the right to decline treatment, and to receive analgesic drugs in quantities sufficient to relieve intolerable distress. Recent Legal judgements show that this is ‘anticipatory’ – it can extend into the future.

Therefore advance directives are held to be legally binding on doctors, and they are now endorsed by the British Medical Association. The Law Commission is planning to introduce a statutory law to confirm this situation.

If doctors are faced with difficult decisions, it is helpful to them to know the considered opinion of the patient, expressed when in full possession of his/her faculties, and not in great pain or distress.

WHAT TO DO NOW AND IN THE FUTURE

The form should be signed, and witnessed at the same time by two persons who are not relatives and who do not expect to benefit from your estate. If necessary, these witnesses could give evidence that you were of sound mind when you signed the form.

If one of the witnesses were to be your doctor, it would be an advantage but it is not essential for the validity of the document. What is essential is that you talk to your doctor about your feelings and wishes.

One form should be given to your doctor with request that it be placed with your medical records; you should retain a second copy. You may also wish to give a third copy to your next of kin or the person you judge best able to protect your interests in an emergency.

It is wise to update your advance directive every few years. The British Medical Association recommends every five years. This can be done by signing and updating the forms, somewhere in the margins.

SOME SUPPORTING STATEMENTS

The British Medical association:

‘The BMA strongly supports the principle of an advance directive….The BMA Council approved in principle the concept of limited legislation to translate the common law into statute….Ethically and legally, if specified in the advance directive, all medical treatments can be withdrawn from the pvs patient.’

In 1994, the Prime Minister Mr. John Major, answered a Parliamentary question by saying:

‘Her Majesty’s Government acknowledges the right to individuals to draw up advance directives. (They) assist patients in the exercise of their legal rights and so ensure their lawful treatment.’

Royal College of Nursing:

‘A living Will may increase patients choice’

Patients Association

‘Bearing in mind the anxieties expressed to us by our members over the years….we felt it right to agree to support (advance directives).’