How will a doctor know what my wishes are if I’m too ill to tell them?

26th March 2020

Most of us have clear views about when and what sort of treatments and medical interventions we would agree to. The question is, how would a doctor or care worker treating you know what those wishes were?

In these unusual and troubled times, it’s a question that becomes particularly relevant.

The basic rule is that if you are well enough to express your views about your treatment, you are the only person who can agree to it.

If you don’t have the capacity to or make a choice or to express a preference, the doctor treating you makes the decision. There are two circumstances where they do not make the decision. They are:

  • if you have a Living Will
  • if you have a Lasting Power of Attorney for Health and Welfare (LPAHW).

A Living Will lets you set out your wishes about medical treatment

A Living Will allows you to express your preferences about your future treatment and what you want to do in certain circumstances. Assuming the health emergency you are experiencing is covered in your Living Will, your wishes will take precedence. A Living Will can also referred to as an Advance Decision or an Advance Directive.

It is as if you had given your decision, in advance.

The most effective Living Wills are explicit about when they are to be used, and specific about the interventions that you do and do not find acceptable. For example, stating you do not want an intervention where you may not have a good quality of life afterwards is too general to have any impact on a doctor’s decision – they take this into account anyway.

A Lasting Power of Attorney for Health and Welfare (LPAHW)

An LPAHW allows you to choose people who will be authorised to make decisions about your treatment on your behalf if you do not have the capacity.

One problem with an LPAHW is that if you don’t already have one in place it can take 3 months for a valid document to be made. To give you reassurance in the interim, you could rely on a Living Will, which is effective from the moment it is signed.

One final point: it is important to note that nothing allows you to demand a particular course of treatment from a doctor. Living Wills and LPAHWs are about choosing whether or not to accept a particular treatment that is offered to you.

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