Advance care planning

Advance care planning is a way to tell others what’s important to you and how you would like to be cared for if you’re unable to tell them yourself. On this page, we explain what your advance care planning might include.

What’s the difference between an advance care plan and advance care planning?

Advance care planning is the umbrella term that encompasses legal documents surrounding your care. It includes an advance decision to refuse treatment (ADRT), lasting power of attorney (LPA) and practical issues, such as your will or plans you have for your funeral.

An advance care plan is a way of expressing your preferences and wishes about care, environment and spirituality. It can be written or verbal, often changes as time goes on and isn’t legally binding.

Your advance care planning may include one or more of the following:

The next three terms (advance statement, advance decision to refuse treatment and lasting power of attorney) are used in England and Wales. In Scotland and Northern Ireland, advance decisions are governed by common law. In Scotland, the equivalent of an LPA is a continuing power of attorney, and in Northern Ireland an enduring power of attorney.

At all times your current wishes and decisions about care and treatment overrule any previous documents or decisions. But considering, discussing, deciding and documenting your current wishes is very helpful to make the best decision for those times when you can’t say so yourself.

An advance care plan

This is a way for you to write down and tell those who are important to you, including health and social care teams, what you know about your illness, and what is important to you about your care and treatment. It’s sometimes called an advance statement or preferred priorities of care (PPC).

It can be used to share your wishes and preferences, as well as help make ‘best interests’ decisions on your behalf in the future if you are unable to say so yourself. Talk to your doctor or nurse and ask for examples of documents that you can use.

You might wish to ask your doctor, nurse or hospice team to keep a copy of this for their records. You can change your mind at any time and any wishes you write down aren’t legally binding.

An advance care plan is different to a will. A will is a legal document used after your death to dictate who inherits your money, property and possessions. An advance care plan isn’t a legal document – it’s a place to record your wishes and preferences as you become less well.

An advance decision to refuse treatment (ADRT)

This is a decision you can make now to say treatments you do not want under any circumstances in the future. It’s sometimes called an advance decision, or a living will.

For example, you may not wish to have a tube feeding you if you have a stroke, even if you may die as a result, or you may not want to be put on a breathing machine called a ventilator. This document is legally binding and is only used if you can’t express your wishes yourself and only for decisions about treatments that you describe in the document.

Your ADRT must comply with the legal specifications outlined in the 2005 Mental Capacity Act. Your doctor or nurse should have examples of documents you can use while completing it together. The charity Compassion in Dying has an example form you can fill out online, with suggestions of things to think about.

An ADRT is not the same as an advance care plan. The NHS has more information about ADRT on their website, including the criteria an ADRT must meet to be valid.

The term ‘living will’ doesn’t have a legal meaning and can be used to refer to either an advance care plan or an advance decision to refuse treatment.

A lasting power of attorney (LPA)

This enables you to give another person the right to make decisions on your behalf. There are two types of LPA:

  • Health and welfare - It only comes into force if you lose the ability to tell those who are important to you your preferences and wishes. Anything done under the authority of the LPA must be in your ‘best interests’. If you have an LPA for health and welfare an ADRT usually isn’t needed, as your LPA can decline treatments on your behalf if they know your wishes.
  • Property and financial affairs - With your permission, it can be used as soon as it is registered. The person you nominate will need to show the document, stamped ‘validated’ on each page, when they act on your behalf.

You have to be over 18 to make an LPA. There are special rules about appointing someone as your LPA, and you must register the forms with the Office of the Public Guardian. You can create an LPA online. It takes up to ten weeks to register an LPA.

Do not attempt cardiopulmonary resuscitation (DNACPR)

A do not attempt CPR (DNACPR) decision provides immediate guidance to health care professionals about the best action to take should your heart stop.

Talk to your doctor or nurse about what this means. You might find these FAQs from the Resuscitation Council UK useful to read through.

You could also talk to your health care professional about the ReSPECT process. It’s a form that allows for a person’s care and treatment preferences known, in the event of a future emergency where they’re unable to make or express a wish or concern. You can read more about the ReSPECT form and see an example copy on the Resuscitation Council UK website. If you live in London, you’ll have access to a different system called CMC (Coordinate My Care).

Practical issues such as your will or plans you have for your funeral

Your will is usually made through your solicitor, who can also help with completing and registering your LPA. Some people also decide to spend time planning their funeral, such as the music and readings they want to be included.

Does my advance care planning need to be in writing?

Advance care planning doesn’t need to be in writing – unless you are making an ADRT or appointing an LPA. However, your family or people who are caring for you might find it helpful if your wishes or preferences are in writing, signed and dated. It’s a good idea to a give a copy of your wishes to everyone who needs to know, keeping a copy for yourself as well. If you make any changes make sure you tell those who need to know.

'Best interests' decisions

The 2005 Mental Capacity Act outlines the process of how to make ‘best interests’ decisions about your care and treatment if you lack the capacity to decide or are unable to say yourself. It applies to all professions – doctors, nurses, social workers, occupational therapists, health care assistants and support staff.

Working out what is in your ‘best interests’ means taking into account:

  • the views of your family, key professional carers and other people you have chosen to act for you
  • any information about what your views might have been about the issue at hand, including your earlier advance care planning.

You can read more about the Mental Capacity Act on the NHS website.

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