8. How to make an advance decision
An advance decision can be as simple or as complex as you want it to be. It is up to you to decide how much detail you include.
You can draft an advance decision yourself using your own words. There is also a template at the end of this factsheet (in the PDF download) that you can use if you want some guidance. If this does not cover everything you want to say, use it as a guide. Add to it or delete from it to ensure that it covers everything you want it to.
Unless you want your advance statement to cover life-sustaining treatment, you can make it verbally – that is, you can say what you want to happen. There is no set format for making a verbal advance decision as it depends a lot on the circumstances when it is made. There are a few things that you can do to ensure that it is still valid, however.
Your verbal advance decision should still be recorded in your medical records by a medical professional as this can help avoid confusion later. The record should include:
- a clear note of the treatment(s) to be refused if you lack the capacity to make the decision at the time
- details about the person who witnessed your decision
- whether or not the health professional heard your decision themselves.
It is always better to make your advance decision in writing, if possible. This ensures that medical professionals are aware of your wishes and that they are correctly understood.
Talk to your GP
It is strongly recommended that you discuss an advance decision with your GP before drafting it. They will be able to explain how your condition is likely to affect you as it progresses, and what treatment you may need. They can help you understand the advantages and disadvantages of choosing or refusing treatment in advance. They can also explain some of the problems that may arise from an unclear statement, and will be able to confirm that you had mental capacity at the time that you wrote your advance decision.
Consider talking to a solicitor
You don’t need to consult a solicitor to make an advance decision, but it can be a good idea. If you are uncertain about what you want to include or how to say it, a qualified solicitor can help make sure that your views are clearly expressed. However, be aware that a solicitor may not be able to advise you on how your condition might progress and the treatments and interventions that may be available. For this you should talk to your GP.
Important information to include
If you choose to draft your own advance decision, this is the minimum information you must include:
- your full name
- your address
- your date of birth
- any distinguishing features (eg tattoos, birthmarks)
- the name, address and telephone number of your GP
- the date you made the advance decision
- your signature
- the dated signature of at least one witness over the age of 18. Ideally this should not be a partner, spouse, relative, anyone who stands to benefit under your will, or your attorney under a Lasting power of attorney
- the name, address and phone number of the people you have nominated to be consulted about treatment decisions, if anyone. This might be your attorney under a Lasting power of attorney for health and welfare, for example
- where relevant, the date that you reviewed – and, if necessary, revised – your advance decision, along with your signature
- if the advance decision applies to refusing life-sustaining treatment, a very clear statement that the advance decision applies to the treatment in question even if your life is at risk.
Although you don’t have to, it is also a good idea to include the following:
- an explanation of when the advance decision should come into effect – for example, it may specify that it comes into effect only if you have a terminal illness
- any specific treatments that you want to refuse, such as cardiopulmonary resuscitation (CPR) or artificial feeding and hydration – for more information on medical treatments that you could include, speak to your GP
- a statement that says your advance decision was drawn up without influence or pressure from other people.
Make copies of your advance decision
You should make a copy of the document for yourself and keep it somewhere safe, You should also make several other copies and give them to the following people:
- your GP, to keep with your medical records
- your hospital team, to place in your case notes
- a close relative or friend
- your attorney under a Lasting power of attorney for health and welfare, if you have one.
Review your advance decision regularly
You should review your advance decision regularly to make sure that it still matches your wishes and preferences. If you want to, you can make changes to it.
To do this, you can start afresh and complete a new form. Or you can make changes to your existing document, making sure you sign and date it again to confirm the changes.
Whether you amend the original form or complete a new one, you must make sure that an independent witness also signs and dates the new version. Be sure to give copies of the revised version to everyone who held a copy of the original version.