Advance Directives in Scotland
An Advance Directive (Living Will or Advance Decision) is a written statement of your wishes to refuse certain treatments in a specific situation.
An Advance Directive is a way of making sure that medical staff and your family know what treatments you don’t want. They can then follow your wishes should there ever be a time when you can’t make decisions for yourself. It will only be used if you lose capacity to make decisions for yourself, for example if you were to become unconscious.
For example, you may want to refuse being given antibiotics for a chest infection if you only had a few days to live. Or you may want to refuse artificial feeding or hydration, if you were to become unconscious or unable swallow food or fluids safely without the help of others, and only had a few days to live.
Benefits to making an Advance DirectiveBack to top
There are several benefits to making an Advance Directive:
- You can feel more in control of your circumstances and future care.
- You can avoid taxing treatments, which may not always be helpful for you anyway.
- Your family and healthcare team will know what you want and can respect your wishes. This can help your family as it will make treatment decisions easier.
- It can help avoid disagreements about your care and treatment within your family or healthcare team.
Who can make an Advance Directive?Back to top
You can make an Advance Directive if you are over 16 years old and you have mental capacity.
Mental capacity when making an Advance Directive
Having mental capacity means that you are able to understand the decision you are making. You need to be able to remember and process any relevant information. You also need to be able to weigh up this information, make a decision and communicate it to your doctor or to others caring for you.
When people are unwell, their mental capacity can change from time to time. Your healthcare team needs to be sure you have the mental capacity to make a treatment decision. If your healthcare team is concerned about your mental capacity, they may need to ask you some questions to help them assess it.
We have more information about mental capacity and the Adults with Incapacity (Scotland) Act (2000).
Who should be involved?Back to top
Before making an Advance Directive, it’s important to discuss the decisions you’d like to make with one of the healthcare professionals involved in your care. This may be your GP, a doctor or a nurse specialist who’s looking after you at the hospital.
You may also want to contact a solicitor. They can help you to put together an Advance Directive and make sure that it accurately reflects your choices and meets any legal requirements. Some people may be able to have legal assistance to help with costs. This means they may not have to pay, or only pay part of, their solicitor’s costs for making an Advance Directive. To find out more about legal aid, speak to your solicitor.
Advance Directives and the lawBack to top
In Scotland, adults with capacity may choose to refuse a medical treatment. If you make an Advance Directive, you will continue your right to refuse treatment if you lose capacity and are no longer able to tell others what you want.
An Advance Directive is highly likely to be legally binding in Scotland if it meets certain criteria. This means your healthcare team must follow it, provided they know about it. Examples of criteria are:
- You must be able to make the decision in the first place (legal capacity).
- The treatment you have chosen to refuse in your Advance Directive applies to your specific circumstances now.
Your healthcare team or solicitor will be able to tell you more about this.
Preparing an Advance DirectiveBack to top
Although an Advance Directive can be made verbally (spoken), it’s better if you write it down. This helps avoid confusion later. There are certain situations where it must be in writing. For example, if it refuses a treatment to keep you alive (such as being put on a ventilator or breathing machine). Your healthcare team or a solicitor will be able to tell you exactly what your written Advance Directive should include.
Once you have written your Advance Directive, it will need to be signed by you and witnessed by someone else. A solicitor is usually there while you do this. The solicitor will confirm (certify) that you understand the document and that you have not been influenced by another person when writing your Advance Directive.
Who should know about my Advance Directive?Back to top
When you’ve made your Advance Directive, it’s important to let the people caring for you know about it. This will usually include your healthcare professionals, next of kin, family and friends, and your welfare attorney if you have one. This can help to avoid any confusion if your condition changes.
People often keep copies at home and give copies to their welfare attorney, GP and specialist nurse. Your healthcare professional can advise you about who else should know about it.
Reviewing your Advance Directive Back to top
Remember to review your Advance Directive regularly so you can be sure it‘s 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 health and social care professionals and the people close to you.
Do Not Attempt Cardiopulmonary Resuscitation (a DNACPR form) Back to top
A cardiac arrest is when the heart stops beating. If the breathing stops, it is called a respiratory arrest. They commonly occur together, which is known as a cardiopulmonary arrest. Cardiopulmonary resuscitation (CPR) is a way of trying to restart the heart and breathing when they have stopped.
You and your healthcare team can discuss in advance whether you would benefit from CPR. The discussion should take into account your health, your wishes, whether CPR would be successful and your quality of life.
If your healthcare team are sure that CPR won’t work, they can decide in advance not to try it. This will be written on a form called Do Not Attempt Cardiopulmonary Resuscitation (a DNACPR form). It will be signed by a senior doctor or a senior nurse who is responsible for your care. This might be a hospital consultant, your GP, a palliative care doctor, a specialist or a consultant nurse. The form will be kept with your health records.
If your healthcare team make a decision not to try CPR, it’s important for you to know that this won’t affect any other care or treatment that you receive. You will still receive the best possible care from the professionals looking after you.
If you’re being cared for at home, and you have a DNACPR form, you will be asked to keep it where it can be easily found. Make sure you tell your healthcare team and the people close to you where it is.
Your healthcare team will regularly review any decision about CPR based on your condition. If you change your mind about the decision, it’s important to discuss this with a member of your healthcare team. However, it’s important to know that you cannot demand CPR if your healthcare team is sure that it won’t work. Remember to tell your family or carers about any changes as it will help to avoid confusion, especially in an emergency.
NHS Scotland has an information leaflet called Decisions about cardiopulmonary resuscitation [PDF, 469kb].