Advance directive
In Scotland, an advance directive is a written statement of your wishes to refuse certain treatments in the future.
What is an advance directive?
In Scotland, an advance directive (or living will) is a written statement of your wishes to refuse certain medical treatments.
It is a way of making sure everyone knows what treatments you do not want to have, if you become unable to make decisions on your own (do not have mental capacity). It will only be used if you cannot make or communicate a decision for yourself.
An advance directive can include the situations in which you wish to refuse the treatment. For example, if:
- you are very ill and you do not want to be given antibiotics for an infection
- you become very unwell after having all possible treatments and you do not want to be kept alive by having a drip or feeding tube
- your condition and quality of life gets worse while you have a feeding tube or drip and you do not want these to continue.
An advance directive can also record whether you want to refuse treatment to re-start your heart and breathing if they have stopped suddenly. This is called cardiopulmonary resuscitation (CPR).
Your advance directive should be as clear as possible about the:
- the treatment you would like to refuse
- situation when you would like your advance directive to apply.
Your advance directive cannot include a request to be given specific treatments, or to have your life ended.
You can only make an advance directive if you live in Scotland. If you live in England or Wales, please see our information about an advance decision to refuse treatment (ADRT).
Who can make an advance directive and who should be involved?
You can make an advance directive if you are aged 16 or over and can make decisions for yourself. This is called mental capacity.
Before making it, talk with someone like your cancer doctor, specialist nurse or GP about the decisions you would like to make. They can explain the likely effects of stopping a medical treatment and what your advance directive should include.
It is also a good idea to discuss your decisions with close family members or friends, so they understand your wishes.
You might also want to contact a solicitor. They can help you to put together an advance directive. They make sure your choices are accurately recorded and meet the legal requirements.
Completing your advance directive
Although you can make an advance directive by speaking to your healthcare team, it is better to write it down. This helps avoid confusion later.
If your advance directive states that you refuse treatments that could possibly keep you alive, it must be in writing.
Once you have written your advance directive, it needs to be signed by you and witnessed by someone else. A solicitor can be there while you do this. They usually want to make sure you:
- understand the document
- have not been influenced by another person when writing it.
An advance directive is likely to be treated as legally binding if it is properly prepared. This means your healthcare team will almost certainly follow it. Your healthcare team or solicitor can tell you more about this.
In some cases, it might be better to have a welfare power of attorney instead of, or as well as, an advance directive. You can ask your healthcare team or your solicitor to help you decide which option is best for you.
Who should know about my advance directive?
When you have made your advance directive, it is important to tell the people involved in your care, including your:
- health and social care professionals
- next of kin – usually your closest living family member or members
- other close family members and friends
- welfare power of attorney, if you have one.
You may choose to keep a copy of your advance directive at home. You can also give copies to your:
- your welfare attorney, if you have one
- your GP – you can also ask that your Key Information Summary records that you have an advance directive
- specialist nurse at the hospital.
You can ask your health and social care team who else should know about it.
Reviewing your advance directive
You can change your mind and rewrite your advance directive at any time. But this must be clearly recorded. Reviewing it regularly makes sure it is up to date and reflects your current wishes. This is important as your wishes may change if your condition changes.
If you decide to cancel your advance directive, tell your healthcare team and the people close to you.
Cardiopulmonary resuscitation (CPR)
Cardiopulmonary resuscitation (CPR) is a way of trying to restart someone’s heart and breathing if they have stopped suddenly.
CPR may be successful in some situations but not in others. Discussing and recording a decision about CPR means it is more likely to be given only when it is useful This can be hard and upsetting to talk about. But it helps your healthcare team understand what is important to you.
You may hear doctors or nurses talk about a ‘do not attempt CPR’ (DNA CPR) decision or form. They may also use a document called ReSPECT. A CPR decision can also be included in an advance directive.
These are written documents that record the decision not to give CPR if someone’s heart or breathing stops. The information is stored in your patient record. It is also usually written on a standard form that you keep with you.
NHS Scotland has 2 information leaflets you might find useful:
You can also ask someone in your healthcare team for a copy of these leaflets.
We have more detailed information about cardiopulmonary resuscitation (CPR).
Good Life, Good death, Good grief can also provide information and support.
About our information
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References
Below is a sample of the sources used in our advanced care planning information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
National Institute for Health and Care Excellence. Advance care planning – A quick guide for registered managers of care homes and home care services. 2019. Available from: www.nice.org.uk/about/nice-communities/social-care/quick-guides/advance-care-planning [accessed May 2023].
National Institute for Health and Care Excellence. Decision making and mental capacity. 2020. Available from: www.nice.org.uk/guidance/qs194 [accessed May 2023].
NHS England. Universal Principles for Advance Care Planning (ACP). 2022. Available from: england.nhs.uk/wp-content/uploads/2022/03/universal-principles-for-advance-care-planning.pdf [accessed May 2023].
Healthcare Improvement Scotland. Anticipatory Care Planning in Scotland: Supporting people to plan ahead and discuss their wishes for future care. 2020. Available from: www.healthcareimprovementscotland.org [accessed May 2023].
GOV.UK. Office of the Public Guardian. Make, register or end a lasting power of attorney. Available from: www.gov.uk/power-of-attorney/make-lasting-power [accessed May 2023].
Office of the Public Guardian (Scotland). Power of attorney. Available from: publicguardian-scotland.gov.uk/power-of-attorney/power-of-attorney/what-is-a-power-of-attorney [accessed May 2023].
Citizens Advice. www.citizensadvice.org.uk [accessed January 2023].
GOV.UK www.gov.uk [accessed January 2023].
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Viv Lucas, Consultant in Palliative Medicine.
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Date reviewed
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