Advance Directives

An Advance Directive is a written statement which lets other people know about any specific treatments that you do not want to have. It may also include the situation when you would want to refuse the treatment.

You can make an Advance Directive if you are aged 16 or over and are able to make decisions for yourself. Before making an Advance Directive, it is important to discuss it with your healthcare team. You may also want to contact a solicitor.

It is important to let the people caring for you know about your Advance Directive. You should also review it regularly so you can be sure it reflects your current wishes.

You may hear doctors or nurses talk about a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision or form. This is a document stating that you do not want to have cardiopulmonary resuscitation (CPR). CPR is a way of trying to restart the heart and breathing when they have stopped. Talk to your healthcare team about making a decision about CPR.

What is an Advance Directive?

An Advance Directive (sometimes called a Living Will) is a written statement of your wishes to refuse a particular treatment. It may also include the specific situation in which you wish to refuse the treatment. It is a way of making sure that everyone knows what treatment you do not want to have if you are unable to make your own decisions in the future.

Here are examples of situations where an Advance Directive can be used:

  • If your illness could not be cured and you became very unwell after all possible treatment, you would not want to be kept alive by being fed or given fluids through a feeding tube or drip.
  • If you are being fed or given fluids through a feeding tube or drip, you do not want this to continue if your condition were to worsen and it is not improving your quality of life.
  • You do not want to be given antibiotics for an infection if you are only expected to live for a few days.

An Advance Directive cannot include a request to have treatment or to have your life ended.

It is important to be as clear as possible about:

  • the circumstances when you would like your Advance Directive to apply
  • what type of treatment you would like to refuse.

Who can make an Advance Directive and who should be involved?

You can make an Advance Directive if you are aged 16 years or over and you have mental capacity.

Before making an Advance Directive it is important to discuss the decisions you would like to make with one of your healthcare professionals. This may be your GP, or a doctor or nurse specialist looking after you at the hospital. They will be able to tell you the likely effects of stopping a treatment. They will also make sure your Advance Directive meets legal requirements.

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.

Occasionally, some people may be able to have legal assistance to help with costs. This means they may not have to pay, or only have to pay part of, their solicitor’s costs for making an Advance Directive. To find out more about legal aid, you can speak to your solicitor or contact the Scottish Legal Aid Board.

Advance Directives and the law

In Scotland, adults with mental capacity may choose to refuse a medical treatment. If you make an Advance Directive, you will still have the right to refuse treatment if you lose capacity and are no longer able to tell others what you want.

Although not tested by the Scottish courts, an Advance Directive is likely to be treated as legally binding in Scotland if it meets certain criteria. This means your healthcare team will almost certainly 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.

What should be included in an Advance Directive?

Although most Advance Directives can be made verbally (spoken), it is better to write it down. This helps avoid confusion later on. 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 can be there while you do this. The solicitor will usually want to make sure that you understand the document and that you have not been influenced by another person when writing your Advance Directive.

In some cases, it may be better for you to have a Welfare PoA instead of, or as well as, an Advance Directive. You could ask for help from your healthcare team or your solicitor to work out which option is best for you.

Who should know about my Advance Directive?

When you have made your Advance Directive, it is important to let the people caring for you know about it. This will usually include your:

  • healthcare professionals
  • next of kin
  • family and friends
  • 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. It is helpful if your GP creates a Key Information Summary (a document that includes key information about your wishes) highlighting that there is an Advance Directive along with a list of the main decisions in it. This means other health professionals can know about your wishes if you need to call for urgent medical help when your GP practice is closed.

Reviewing your Advance Directive

Remember to review your Advance Directive regularly so you can be 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 health and social care professionals and the people close to you.

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)

What is a DNACPR decision?

A cardiac arrest is when the heart stops beating. If breathing stops, it is called a respiratory arrest. They commonly happen 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 may hear doctors or nurses talk about a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision or form. This is a written document stating to not give cardiopulmonary resuscitation (CPR) if someone’s heart or breathing stops.

A CPR decision may be made and recorded on a Scottish DNACPR form if:

  • a person asks for a DNACPR form because they do not want CPR under certain circumstances
  • your health is getting worse and your doctors feel that CPR would not work.

Making a decision about CPR

If you have not made a decision about CPR and you want to, you should discuss this with your medical team or specialist nurse. You may also want to talk this through with your family, a close friend or a spiritual carer such as a chaplain.

Your medical team will be able to tell you how successful CPR is likely to be in different situations. They will take into account any other health problems you have. For example, you may have a cancer that cannot be cured but you are expected to live with the condition for a long time, sometimes years. In this situation, you may want to know about CPR and the doctor will make sure that you have all the information you need to make a decision. They will tell you what is likely to happen if you have CPR, how this might extend your life and what your quality of life might be.

If your healthcare team are sure that CPR will not work or will have a poor outcome, they can decide in advance not to try it. They will write this down on a DNACPR form. If your doctor feels that CPR will not be successful, but you do not agree, you can ask for a second medical opinion from another senior doctor. They should also involve your family in these discussions, unless you have specifically asked them not to. Your healthcare team will take your wishes about CPR into account. However, you cannot insist a doctor attempts CPR if, in their clinical judgement, they think it will not work.

After a decision has been made

A senior doctor or nurse who has responsibility for your care signs the DNACPR form after a decision has been made with you and involving those close to you. The form is kept in your records if you are in hospital, at home with you, or by care home staff. The Key Information Summary has a record of any CPR decisions. If your healthcare team decide not to try CPR, it is important to know that this will not affect any other care or treatment you have.

If you are at home, you will be asked to keep a written record of your DNACPR form where it can be found easily. Emergency services, such as out-of-hours ambulance services and doctors, can then see it, even if your Key Information Summary is not available or up to date. If you go to hospital, take the form with you.

NHS Scotland has an information leaflet called Decisions about cardiopulmonary resuscitation. You can also ask someone in your healthcare team for a copy of this leaflet.

Back to Advance care planning in Scotland

Planning ahead

Planning ahead can help people know what care you would like if you become unable to make choices yourself.

Making a will

Having an up-to-date will ensures that your wishes for who you would like to leave your estate to are guaranteed.

Your wishes for your care

When you are planning ahead, it is important to think about how and where you would like to be cared for.

Power of Attorney

A Power of Attorney (PoA) allows you to choose someone to make decisions on your behalf.

Funeral planning

Planning your funeral in advance means your family and friends can arrange the type of funeral you would like.

Mental capacity

The Adults with Incapacity (Scotland) Act 2000 aims to protect people who cannot make a decision for themselves.