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Health Care Directive

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Advance Decision of ____________________

I, ____________________, of ____________________, England, being of sound mind and over the age of 18 years, make this Advance Decision fully understanding the consequences of my action in doing so. I intend this Advance Decision to be read by my health care providers, family and friends as a true reflection of my wishes and instructions should I become incapacitated and unable to communicate such wishes and instructions.

  1. DEFINITIONS

    As used in this document:

    1. "Health Care Provider" means any person licensed, certified or otherwise authorised by law to administer health care in the ordinary course of business or practice of a profession.
    2. "Terminal Condition" means a condition caused by injury, disease or illness from which there is no reasonable medical probability of recovery and which, without treatment, can be expected to cause death.
    3. "Persistently Unconscious" means being in a profound state of unconsciousness caused by disease, injury, poison or other means from which there exists no reasonable expectation of regaining consciousness.
    4. "Severely and Permanently Mentally Impaired" means being in a permanent and irreversible state of mental impairment in which there is:
      1. The absence of voluntary action or cognitive behaviour; and
      2. An inability to communicate or interact purposefully with the environment.
    5. "Life Support" means any medical procedure, treatment or intervention which sustains, restores or supplants a spontaneous vital function. In this document the term does not include tube feeding or the provision of medication or the performance of a medical procedure when such medication or procedure is deemed necessary to provide Comfort Care or to alleviate pain.
    6. "Tube Feeding" means the provision of nutrients or fluids by a tube inserted in a vein, under the skin in the subcutaneous tissues, or in the stomach (gastrointestinal tract).
    7. "Cardiopulmonary Resuscitation" means restoration of heartbeat and breathing following cardiac arrest, using artificial respiration and external cardiac massage.
    8. "Comfort Care" means treatment, including prescription medication, provided to the patient for the sole purpose of alleviating pain and discomfort.
  2. TREATMENT DIRECTIONS AND END-OF-LIFE DECISIONS

    I direct that my health care providers and others involved in my care provide, withhold or withdraw treatment in accordance with my directions below:

    1. If I have an incurable and irreversible Terminal Condition that will result in my death within a relatively short time, I direct that:
      1. I not be given Life Support or other life-prolonging treatment;
      2. I not receive Tube Feeding even if withholding such feeding would hasten my death;
      3. I not receive Cardiopulmonary Resuscitation in the event of cardiac arrest; and
      4. Should I develop another separate condition that threatens my life, such other illness not be given active treatment unless it appears to be causing me undue suffering.

Advance Decision Information

Alternate Names:

An Advance Decision is also known as a/an:

  • Living Will
  • Advance Directive
  • Advance Care Directive
  • Health Care Directive
  • Advance Decision to Refuse Treatment (ADRT)

What is an Advance Decision?

An Advance Decision is a document that individuals use to outline their wishes with respect to their health care and medical treatments in the event that they are unable to communicate this information themselves.

LawDepot's Advance Decision can be customised for:

  • England
  • Northern Ireland
  • Scotland
  • Wales

Who needs an Advance Decision?

Most people would benefit from creating an Advance Decision that outlines the medical treatments and care they will or won't consent to in the event of a medical emergency.

In particular, the following individuals should create an Advance Decision:

  • Individuals who have chronic health issues
  • Individuals who have been diagnosed with a life-threatening or terminal illness
  • Individuals who are reaching old age
  • Individuals who are preparing for travel
  • Individuals who are preparing for an event that can result in injury (such as a marathon or skydiving)

What information is included in an Advance Decision?

An Advance Decision will typically include:

  • Information about the person creating the document, including their full name, address, gender, and birthdate
  • An advance statement of values and beliefs (if any) that outlines a person's core values and religious or spiritual beliefs as they relate to medical treatment and health care
  • Decisions on treatments in the event of a terminal condition, persistent unconsciousness (such as a coma), and severe and permanent mental impairment (this may include decisions on whether or not you authorise life support, CPR, etc.)
  • Whether or not you consent to organ donations or certain prescription medications that may negatively impact your health (such as medication for pain relief or behaviour control that may worsen your condition)
  • A signature from the person creating the document and any individual who is acting as a witness to the document
  • The location in which the document was signed

What are some of the terms found in an Advance Decision?

An Advance Decision will generally list a particular medical state (such as persistent unconsciousness) and the treatments or life-sustaining measures that medical professionals may use to care for a person in that condition.

Some terms used in LawDepot's Advance Decision include:

  • Terminal condition: when a person's condition or illness is incurable and will likely lead to the person passing away
  • Persistent unconsciousness: when a person is completely or nearly unresponsive (unconscious) and lacks both self-awareness and any awareness of their environment (for example, the person is in a coma)
  • Severe and permanent mental impairment: when a person has a permanent and irreversible condition that leaves them unable to communicate purposefully or make voluntary movements (for example, in some situations, a traumatic brain injury can cause severe and permanent mental impairment)
  • Life support: a procedure, treatment, or intervention used by medical professionals to maintain a person's vital functions, such as when a ventilator is used to help someone breathe
  • Cardiopulmonary resuscitation (CPR): an emergency lifesaving procedure involving chest compressions and ventilation that is used to revive someone who is unresponsive (i.e. not breathing and has no heart beat) to prevent them from passing away
  • Tube feeding: a method of getting nutrients into body through a tube; it is used when a person cannot eat, drink, or swallow properly or cannot get enough nutrients to their body by eating or drinking and requires additional sustenance
  • Intervening illnesses: another illness (separate to the original illness you were being cared for) that occurs during care or treatment (for instance, if a person who is being treated with a heart condition gets pneumonia)

What is the difference between an Advance Decision and advance statement?

An Advance Decision is a document that a person can use to communicate decisions about health care and treatment in the event that they are unable to. An advance statement is generally included with an Advance Decision, and its purpose is to allow an individual the opportunity to express their beliefs or values that may impact their care and treatment.

For instance, individuals of certain religions may be unable to eat certain foods or foods that have not been prepared in a particular way. If someone of a religion with this dietary restriction created an Advance Decision, they would be able to include an advance statement to indicate how their beliefs affect their diet and what caregivers can do to accommodate them.

What cannot be included in an Advance Decision?

Typically, an Advance Decision cannot be used to:

  • Tell health care professionals to treat you in a manner that contradicts the law (for example, if medical assistance in dying is not legal in your country, you cannot request it in response to a terminal illness)
  • Refuse drugs that are intended to relieve pain (unless taking such drugs will worsen your condition)
  • Request treatments that medical professionals do not think are appropriate
  • Refuse being given nutrients by mouth (i.e. through food or drink)

Related Documents:

  • Last Will and Testament: create a Last Will and Testament to communicate important instructions (such as child guardianship) and to dictate how you want your estate to be divided after you pass away
  • Power of Attorney: create a Power of Attorney to give another person the authority to make decisions on your behalf with respect to finances, business, and more
  • Revocation of Power of Attorney: draft a Revocation of Power of Attorney to rescind someone's ability to make decisions on your behalf
  • Child Medical Consent: use a Child Medical Consent to give another person the authority to make medical decisions for your child

Frequently Asked Questions:

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