Making choices when you have advanced cancer
You may need to make important choices in the later stages of your illness. However, there may come a time when you can’t make decisions or communicate easily.
Some people choose to write down their wishes in advance, or appoint someone to make decisions on their behalf, should a time come when they are no longer to able to do this themselves.
Advance statements/decisions to refuse treatment
Back to top
Normally you will discuss how you would like to be treated and which treatments you don’t want to have with your doctor or other healthcare professionals. Some people write down their choices in advance so that if they become unable to discuss things with their doctors or make decisions, the doctors will still know what their wishes are.
Instructions about the treatments you do or don’t want are called advance statements and advance decisions. They are sometimes known as living wills.
An advance statement is a general statement of your views and wishes. It can indicate the treatment you would prefer to have and can include non-medical things, such as your food likes and dislikes or religious beliefs. An advance statement is not legally binding, but your doctors should take it into account when deciding what’s best for you. It can be very helpful if you write down your preferences and wishes. If you do this, the key people involved in your care will know how you wish to be cared for.
An advance decision to refuse treatment is simply a decision made in advance to refuse to have certain treatment. For example, you may decide that if your condition suddenly worsens and your breathing stops, you don’t want people to try to bring you round (resuscitate you). In England and Wales, an advance decision is legally binding and must be respected by your doctors. In Scotland, an advance decision is known as an advance directive and isn’t legally binding. However, it must be taken into account by the medical team and others making decisions on your behalf. In Northern Ireland there is currently no legislation covering the use of advance decisions to refuse treatment, advance statements or living wills.
Making an advance decision to refuse treatment means you need to say which treatment/s you do not wish to have and the circumstances in which you don’t want treatment. You can change your mind and rewrite your advance decision at any time. A copy of your advance decision to refuse treatment can be kept in your medical and nursing notes.
We have a section about advance decisions, which you may find helpful. You may also find it helpful to read the leaflet Planning for your future care: a guide, which has been produced by the NHS National End of Life Care Programme. You can ask for a copy from your GP or at your local hospital information centre. The leaflet is also available on the Department of Health Care Network’s website.
It’s important to discuss your wishes with a medical professional such as your GP or consultant. Remember that your family and friends may see things very differently from you. If possible,
it’s good to have an honest and open discussion with your partner, relatives or closest friends in advance, so that they know and understand your wishes.
A power of attorney gives someone you trust the right to make decisions about your financial, legal or health affairs if you become unable to do so. Some types of power of attorney allow the person to make decisions about your care and treatment. Other types allow the person to make decisions about your property or financial affairs.
The laws covering powers of attorney are different across the UK. A legal adviser, or organisations such as Citizens Advice, can give you more information about how the laws apply where you live.
You can also get more information from The Public Guardianship Office (England and Wales - tel 0300 456 0300begin_of_the_skype_highlighting 0300 456 0300 end_of_the_skype_highlighting), The Scottish Office of the Public Guardian (tel 01324 678300) or The Office of Care and Protection (Northern Ireland - tel 028 9072 4732 or 028 9072 4733)
In Northern Ireland it’s possible to appoint other people to make decisions about your financial affairs but not about your care and treatment. New legislation to cover these areas is being considered by the Department of Health, Social Services and Public Safety, and is expected in 2011.