Advance Statement and Advance Directives
For all of us, the time may well come when we’re unable to make decisions or express our wishes. I’m not talking about whether we wish to have a G&T before dinner instead of a sherry. But rather wishes about what we want our care to look like and what medical treatment we do and do not want. This is where advance statements and advance directives come in.
As the Independent Age website points out, an advance statement records how you’d like others to look after you should you lose your mental capacity. Anyone involved in your care should consider it. Note though that such a document isn’t legally binding. Even so, it helps in getting your wishes respected should this situation come about.
The type of information you might record on your advance statement includes:
- Where you’d like to be cared for
- What food and drink you like
- Baths or showers – which you prefer
- Your values and beliefs – and the effect they have on your routine and care
- What you like doing, what TV and radio programmes you enjoy
- Who you want the medical world to consult about your care
- Who you want to visit you – and who you don’t
- And anything that you absolutely do NOT want to happen to you.
Advance Directives or Decision
You can use this document to specify to those in charge of your care, what treatments or care you want to refuse – and in what circumstances – should you not have mental capacity at that time.
The formal name for such documents is Advanced Decisions to Refuse Treatment. So long as specific criteria is met they’re legally binding in England and Wales. Once you’ve made such an advanced decision healthcare professionals must abide by it.
You can use an advance decision/directive to refuse any treatment, including life-sustaining treatment such as:
- Artificial feeding
- Mechanical breathing ventilation
- Resuscitation if you stop breathing or if your heart stops.
There are three key things to consider when writing these documents:
- In the first instance, you should discuss with your attorneys issues around life-sustaining treatment – and whether you want it or not.
- Address issues around end-of-life care – what kind of care you want. For example, would you want to be in a hospice? Or would you prefer to be at home and have Macmillan nurses come to you?
- Lastly, you must talk to your attorneys and let them know your wishes now and your feelings about long-term care. Again, the issue is one of maintaining your independence as long as possible – or your willingness to enter a care home.
At this point, I want to bring in a most interesting and thought-provoking book, by Atul Gawande, called Being Mortal. This book reflects on how we can better live with age-related frailty, serious illness, and approaching death – our mortality. In it, Gawande issues a call for a change in how medical professionals treat patients whose lives are drawing to a close.
Gawande points out the triumph of medicine in modern times. How it’s transformed the dangers of childbirth, injury, and disease. How modern medicine has taken such things from always harrowing and often fatal to something manageable. And yet, when we come face-to-face with the realities of aging and death, he argues that medicine’s offerings run counter to what they should.
Using eye-popping research and personal experiences, Gawande highlights the suffering produced by this dynamic. So, we have nursing homes far too concerned with what elderly residents/patients eat. Does someone in their eighties really need a healthy diet? If they want to consume a bottle of Shiraz every night then why shouldn’t they? He further posits that doctors, uncomfortable about discussing patients’ anxieties about death, fall back on false hopes and treatments that are actually shortening lives instead of improving them. And families go along with all of it.
All of which brings me back to the topic of this post. With advanced statements, you or your relative can write out your wishes with respect to long-term care, quality of life, and end-of-life care. That way, it’s all available and your wishes are clear to all when you or they can’t speak up.
I advise you to also have an advanced directive completed with your/their GP that would then deal with medical wishes and care. It’s a good idea to get these two documents in place if you/they are not getting powers of attorney.
If this post has raised questions – and I can well imagine it might – do not hesitate to get in touch. You’ll find all my contact information on my website here.