Advance Directive Policy (2018)

The term advance directive (increasingly being replaced by the term advance decision) means a statement explaining what medical treatment the individual would not want in the future, should that individual 'lack capacity' as defined by the Mental Capacity Act 2005. The term 'living will', whilst helping people to understand the concept, is somewhat misleading in that, unlike a will, it does not deal with money or property. Moreover, it can relate to all future treatment, not just that which may be immediately life-saving. An advance directive is legally binding in England and Wales. Except in the case where the individual decides to refuse life-saving treatment, it does not have to be written down, although most are and a written document is less likely to be challenged.

Whilst the patient has capacity, their word overrides anything contained in their advance directive or anything their legal representative may say.

If doctors have doubts about the validity of an advance decision they should consult early with their indemnity organisation and they may be able to apply to the Court of Protection to overrule it.

In Scotland and Northern Ireland the situation is somewhat different. Advance decisions are governed by common law rather than legislation. However, providing the decision was made by an adult with capacity and clearly sets out the person's intentions, it is highly likely that a court would consider it legally binding.

The term advance statement is sometimes used. This is an expression of the individual's desires and may refer to personal values, principles and religious beliefs. It is not legally binding but may act as a guide to a doctor who has to make a decision on behalf of a patient who lacks capacity.

Detailed below is the Garstang Medical Practice policy around supporting our patients over issues relating to advance directives / decisions.

Further NHS guidance with detailed support and useful links can be found on this page at NHS.uk.

Practice Policy

The Practice abides by the British Medical Association (BMA) and other legal guidelines for advance directives.
Each request from a Patient will be considered by that patient’s own GP.
Appropriate advice will be offered relating to the consequences of the request.
The Practice generally supports the principle of patient choice in the provision of treatment and will take the Directive into account in its provision of treatment.

How to register an Advance Directive with the Practice

Bring the original document and identification containing a signature (e.g. Passport or Driving Licence).

Make an appointment at least 4 weeks in advance with your GP, advising the Receptionist that an Advance Directive is to be discussed.

What the Practice will do

We will make copies of your documents and return the originals to you.
Your GP will study the content of your documents to prepare for the consultation.
At the consultation, your GP will discuss with you the clinical implications of your decision and take into account your health situation to ensure that you fully understand the nature of your request.
If you confirm that you wish to proceed, your GP may ask you about your Advance Directive again in the future if you come for a consultation.

Our medical records will be updated with an image of your documents and an alert placed on your record which will be seen each time your record is opened.

We will provide details to other health professionals involved with your treatment as needed, e.g. where a hospital or other referral is necessary.

Patient Responsibilities

Maintain and securely retain your original Advance Directive document.
Regularly re-affirm in writing that the Advance Directive document is still valid – it is recommended that this is done every 12 months.
Ensure that your family and close friends are aware of your Advance Directive document and where it is kept.

What the Practice Will Not do

Remind you to review or update your directive.
Monitor your treatment elsewhere (other than supply a copy of your directive).
Express views on the acceptability or legality of the directive in the wide variety of potential future clinical circumstances, or treatments which may be needed.
Be responsible for the provision of Advance Directive information to other health providers where the Practice has not been involved in the care process (e.g. private clinics, temporary registration elsewhere etc.).