MAKING DECISIONS ABOUT HOW YOU WOULD LIKE TO BE CARED FOR
Making an advance decision to refuse treatment (ADRT) is one way of ensuring that our decisions about treatment we don’t want are respected. It can be as simple as writing a statement and signing it, but it’s better to be guided through the process to make sure that the words we use are clear and legally enforceable. For example, if someone writes “I refuse to accept any treatment whatsoever if I am so sick that I could be dying”, this would certainly stop doctors using drips, feeding tubes and ventilators, but it also means they would be unable to treat symptoms that might distress us.
Asking experts who understand the medical as well as the legal aspects is better than asking a lawyer, who may not be able to help you craft the document to fit specific health needs.
During the Covid-19 epidemic, GPs are trying to ensure that every patient’s wishes are explored and recorded. This process is called advance care planning (ACP) and is something that was encouraged for anyone with serious health problems long before this pandemic.
Now, it has become even more important to be aware of people’s wishes, and GPs may get in touch to discuss “what if…” Many people have already decided that, rather than risk dying in isolation in hospital, they would remain with loved ones at home. Both of those decisions are valid in ACP.
Anyone keen to engage in ACP should contact their GP to arrange a discussion over the phone. Another option is naming specific people who can speak for us if/while we are too unwell to join in healthcare discussions for ourselves.
Without completing and registering a lasting power of attorney (LPA), no one – not even our chosen next-of-kin – has the right in law to make decisions on our behalf. Parents have this right until their child is 18, but after that, only legally appointed attorneys may do so.
The attorney process can be completed online or you can send for the documents; there is a cooling-off period and some safety checks before the LPA can be registered with the Office of the Public Guardian (for which there is a small fee). It takes at least six weeks, so it’s not as rapid as an ADRT.
LPA is the method in England and Wales; it has a different name (but similar status) in Scotland; and there is not yet such a power in Northern Ireland, although change is in progress there.