In the UK, the term “living will” is often used interchangeably with “advance directive” or “advance decision”. It refers to a legal document that allows an individual to express their wishes about medical treatment and care in case they become unable to communicate or make decisions due to illness or incapacity. However, the formal term used in the UK is typically an advance decision or advance decision to refuse treatment.
Key Features of a Living Will (Advance Decision) in the UK:
- Medical Treatment Preferences: A living will or advance decision allows you to state which medical treatments you do or do not want to receive in the future, in case you become seriously ill or incapacitated. For example, it can specify whether you want to refuse life-sustaining treatments like artificial ventilation or resuscitation if you are in a terminal or irreversible condition.
- Legally Binding: In the UK, if you make an advance decision (living will), and it complies with the legal requirements, it is legally binding. Healthcare providers must follow your wishes, provided the situation aligns with the terms of the advance decision.
- Refusing Treatment: Unlike some advance directives in other countries, a UK living will specifically allows individuals to refuse treatment, but it doesn’t allow for euthanasia or assisted suicide (which remain illegal in the UK). For example, you might refuse life support but could still want palliative care to ensure comfort.
- Conditions for an Advance Decision:
- Capacity: You must have the mental capacity to make an advance decision at the time you create it. This means you need to understand the decision you’re making and the consequences of your choices.
- Clear Instructions: The decision needs to be clear, specific, and relate to situations where you would be unable to make decisions for yourself.
- Written and Signed: It is best to put the advance decision in writing, sign it, and ideally have it witnessed, although verbal advance decisions can also be valid in certain cases. If you’re refusing specific treatments, the decision must be written to be legally enforceable.
- End-of-Life Decisions: An advance decision can cover various aspects of end-of-life care, including whether you would want to be resuscitated or kept alive through life-sustaining treatment if you are in a coma or have a terminal illness.
- Not the Same as a Living Trust or Will: A living will (advance decision) should not be confused with a will that addresses the distribution of assets after death, or a living trust that might involve how assets are managed during someone’s lifetime.
- Advance Care Planning: Alongside an advance decision, you might consider creating a healthcare proxy (also called a lasting power of attorney for health and welfare) to appoint someone who can make decisions on your behalf if you’re unable to do so.
Differences Between a Living Will and a Lasting Power of Attorney (LPA) in the UK:
- Living Will (Advance Decision): Specifically addresses your medical treatment preferences and the refusal of certain treatments if you’re unable to express your wishes.
- Lasting Power of Attorney (Health and Welfare): Appoints someone to make medical decisions for you if you become incapacitated, but it does not specify your wishes in advance. This can complement a living will by ensuring someone can act on your behalf if your situation is not covered in the living will.
Examples of Things to Include in a Living Will:
- Whether you want to receive life-sustaining treatments if you’re diagnosed with a terminal illness.
- Refusal of treatments like artificial feeding, ventilation, or resuscitation if there is no hope of recovery.
- Wishes about pain relief and palliative care.
- Organ donation preferences.
How to Make an Advance Decision (Living Will) in the UK:
- Write it down: Clearly state the treatments you do or do not want in a variety of scenarios.
- Sign and Witness: To ensure it’s legally binding, have the document signed and witnessed.
- Inform Healthcare Providers: Share the advance decision with your doctor and loved ones to ensure everyone knows your wishes.
- Keep it Updated: Review and update your living will as your situation or preferences change.
Important Legal Considerations:
- An advance decision is legally binding as long as it is clear and meets the requirements, such as specifying the exact treatments you would refuse.
- It is important to ensure your healthcare provider is aware of your advance decision so it can be respected when needed.
- You can revoke or change your advance decision at any time, provided you have mental capacity.