By Clare Fuller
My name is Clare Fuller and I am an advocate for Advance Care Planning. I believe passionately in proactive Advance Care Planning, campaigning to raise public awareness and professional understanding. As a nurse, I have seen first-hand and too often what can happen when vital conversations and plans are left too late and I am on a mission to normalise talking about our Advance Care Planning.
There are many elements to Advance Care Planning and what is most appropriate for you will depend on your stage of life; this post will look at two specific elements and these are lasting Power of Attorney and an Advance Decision to Refuse Treatment.
What is Lasting Power of Attorney
A Lasting Power of Attorney is a document that enables you to choose in advance who would speak for you if you ever lost the capacity to make decisions for yourself through a sudden accident or a progressive disease. You can find out more about why you need one as part of your Advanced Care Planning here.
A Lasting Power of Attorney enables someone to speak on your behalf, but does not have to specify examples or what your wishes are. There is a section for you to add preferences and instructions but it is not a mandatory part of completing a Lasting Power of Attorney.
You can find out more and see examples of what might be included in the UK as a preference or instruction here.
It’s really important that you talk to your attorneys about what matters most to you so that if they ever need to make a decision for you they will know what to do. Many people support a Lasting Power of Attorney with a personal statement of wishes and preferences.
The key takeaway is a Lasting Power of Attorney enables someone to make decisions for you but does not need to specify what these decisions are.
What is An Advance Decision to Refuse Treatment?
An Advance Decision to Refuse Treatment is a legal document which sets out specific treatments you may wish to refuse in the future. The NHS provides the following definition:
To make a valid Advance Decision to Refuse Treatment:
- A person must be over 18 and have capacity
- The Advance Decision to Refuse Treatment must be written down, signed and witnessed
- It must also have the following statement “I confirm the following refusal of treatment even if my life is at risk or may be shortened as a result”
An Advance Decision to Refuse Treatment could include clinically assisted nutrition and hydration, mechanical ventilation, antibiotics for a life-threatening condition and cardiopulmonary resuscitation. Compassion in Dying provide a template for making an Advance Decision to Refuse Treatment.
You can listen to Advance Decision to Refuse Treatment with Celia Kitzinger to find out more about an Advance Decision to Refuse Treatment. Celia shares how a devastating family experience provided the catalyst for her work and provides clarity and insight into ADRTs and the MCA (Mental Capacity Act) . Celia talks through the process of making an ADRT and why an Advance Statement of wishes and preferences is so very important.
The key takeaway is an Advance Decision enables a person to refuse a specific treatment in a specific circumstance.
What takes priority, a Lasting Power of Attorney or an Advance Decision to Refuse Treatment?
Deciding whether a Lasting Power of Attorney or an Advance decision to Refuse Treatment takes propriety, depends on the order they were written in. The most recent document will take priority. This means that if you write an Advance Decision to Refuse Treatment before a Lasting Power of Attorney then your attorneys could potentially override the Advance Decision to Refuse Treatment.
What are the similarities in a Lasting Power of Attorney and an Advance Decision to Refuse Treatment?
A Lasting Power of Attorney and an Advance Decision to Refuse Treatment are both options you can use to plan ahead for a time when you may not have capacity, they are both part of Advance Care Planning. When creating either document, it would be good to have a supporting Advance Statement of your wishes. Whilst not a legal document, an Advance Statement can be a valuable tool for you to set out your wishes and preferences.
Using Joy Lists can be another way of documenting your wishes and what is important to you. I had the pleasure of talking with Andrew Sanderson about Joy Lists and you can hear Andrew explain how they can help in Advance Care Planning.
The following table summarises the key differences between a Lasting Power of Attorney and an Advance Decision to Refuse Treatment
To summarise
A Lasting Power of Attorney and an Advance Decision to Refuse Treatment are important legal tools, and a valuable part of Advance Care Planning. Both help you plan for a time when you may lose capacity through sudden accident or progressive disease, both enable you to have more control – the Lasting Power of Attorney by nominating someone to be your future voice and an Advance Decision to Refuse Treatment by saying now what you don’t want in the future.
I hope this post will help raise awareness about Lasting Power of Attorney and Advance Decisions to Refuse Treatment, maybe you could use it as a conversation started with the people that you love?
If you want to find out more or wish to enquire about making your Lasting Power of Attorney or Advance Decision to Refuse Treatment contact me. I will be hosting a free on-line event exploring Lasting Power of Attorney and Advance Decision to Refuse Treatment on Monday 31st July 2023 and you can reserve your ticket through Eventbrite .
Clare Fuller is a Registered Nurse with 30 years’ experience in End-of-Life Care for which she is a Care Quality Commission Specialist Advisor. She campaigns for proactive Advance Care Planning and is the host of the Conversations about Advance Care Planning podcast.
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Last Updated on July 13, 2023 by Editorial Staff
