It’s all about you, isn’t it?
How do you want to live your life? What medical treatment would you not want to receive? Where would you like to live? Who would you like to see, or not see? While you are able to do so, you can just tell people. But what if you are unable to do so through loss of mental capacity or due to physical disability? It is so important that you empower people to take fundamental decisions for you or set in stone what you want to happen.
That is where Health & Welfare Lasting Powers of Attorney, Advance Decisions To Refuse Treatment and Advance Care Statements come in. These are vital tools to ensure that, when you cannot communicate for yourself, you are able to live the life you want.
So what’s the difference between these documents and do you need them all?
Health & Welfare Lasting Powers of Attorney
Under a Health & Welfare Lasting Power of Attorney you can someone (or more than one person) to make decisions on your behalf regarding your health and personal welfare matters. The authority of the attorney is wide ranging covering medical treatment, care decisions, daily living arrangements and dealing with personal communication and contact. Importantly, you can authorise a Health and Welfare Attorney to take life-sustaining treatment decisions, such as whether a life support machine should be switched off.
The power of attorney must be registered with the Office of the Public Guardian before it can be used. Once registered the power of attorney can only be used to make decisions that you are unable to take yourself. The attorney must take those decisions in your best interests. While attorneys must consider your wishes when deciding what to do they do not have to abide them. This means that a power of attorney is quite flexible, allowing attorneys to consider the circumstances and take decisions in your best interests at the time. Indeed, if a carer or medical professional believes that an attorney is not acting in your best interests, they can refuse to comply with and challenge the decision.
Advance Decisions To Refuse Treatment
An Advance Decision, also known as an Advance Directive or, confusingly, a “Living Will”, allows you to give directions in advance about your medical treatment. Instead of appointing someone to take decisions for you the Advance Decision tells the treating medical professional what treatment you do not want to receive.
It does not have to be registered but must contain specific wording to be effective. You cannot require doctors to provide treatment using an Advance Decision but it can set out circumstances in which you do not consent to treatment. For example, it could state that you refuse all blood transfusions.
One of the key differences to a power of attorney is that a valid Advance Decision is binding on medical professionals, regardless of whether they consider the refusal of treatment is in your best interests.
Because of their inflexibility it is important to set out clearly the circumstances in which you want the Advance Decision to apply.
Advance Care Statement
An Advance Care Statement is a less formal document that allows you to set out your wishes about what care and medical treatment you would/would not like to receive.
It is not binding on the treating medical professionals but must be taken into account when decisions are taken on your behalf. In essence it is a statement of “wishes”.
Although not binding an Advance Care Statement can be invaluable to individuals taking decisions about your care and medical treatment to help them understand what is important to you so they can aim to give you the life you want.
Interaction
It is possible to make all three documents but care and advice are required. In general, signing a Health and Welfare Lasting Power of Attorney will rescind a previous Advance Decision. Alternatively, an Advance Decision made after a Lasting Power of Attorney needs to be carefully worded to consider how it will impact on the attorney’s decision making.
An Advance Care Statement can work well alongside a Lasting Power of Attorney but it is important to ensure there is no contradictory guidance in the documents.
Wishes expressed in an Advance Care Statement will be overridden by anything contained in an Advance Decision. However, an Advance Statement can give useful guidance about treatment decisions not covered in the Advance Decision.
Things to think about
Regardless of which documents you put in place it is essential to keep them under review. Your wishes may change over time, there may be advances in medical treatment that could improve your quality of life, attorneys may become unable or unwilling to act.
It is vital to notify carers and medical professionals to the existence of any documents you put in place so they know who to contact and what steps to take.
If you cannot decide for yourself then what happens to or for you must, rightly, be all about you.
