Advance care planning

Before any treatment or procedure, healthcare staff must make sure they have consent from you.

Giving and refusing consent is the means by which you can choose to accept or refuse medical treatments.

Consent can be given verbally or in writing. Valid consent must be:

• Voluntary: The decision must be made by you, and not be influenced by pressure from medical staff, friends or family;
• Informed: Healthcare staff must provide information about the treatment;
• Including the benefits, risks and any alternative treatments, in a language you understand, or in an audiovisual format if that is easier.

The person giving consent must also have the capacity to make this decision. This means you understand the information you’ve been given, and can use this information to make a decision.

There is more information about consent, capacity and consent for children and young people on the NHS website.

Advance Care Planning supports people to think ahead about what's most important to them as they approach end of life.

Most adults have the capacity to make decisions about their treatment, but this can change over time with illness.

Examples where someone might not have this capacity is when they have conditions like dementia, brain damage, or severe learning disabilities.

It is a good idea to talk about the type of care and treatment you might want with people who are important to you, such as a partner, your family or doctor. This is called advance care planning.

Advance plans can also be made for everyday decisions that might have nothing to do with medical treatment, such as the place where you would want to be looked after if you become incapable of looking after yourself.

If you have not made an advance care plan and you become too unwell to make decisions for yourself, your next of kin will be consulted by medical staff.

Your advance care plan can include refusing life-prolonging treatments.

You can refuse any treatments except basic care, which includes nursing care, pain relief, relief of other symptoms, and the offer of food or drink by mouth. This can also be referred to as comfort care. There is more information about this on this page [link]

If you live in England and Wales you can make an advance decision to refuse treatment (ADRT), or an advance directive if you are in Scotland.

In Northern Ireland, an ADRT is legally binding (governed by common law instead of an Act) if it is valid and applicable to the particular situation. This means those providing care, support or treatment must follow an ADRT provided that they know about it.

The ADRT must be in writing, and signed by you and a witness for doctors and nurses to recognise it as a legal document. It is a good idea to speak to a healthcare professional about your choices before making decisions about refusing treatment.

In the ADRT you can say:

• which treatments you don't want
• in what circumstances you don’t want treatment
• that you refuse treatment that could potentially keep you alive (known as life-sustaining or life-prolonging treatment). These include resuscitation, artificial feeding and hydration given by a tube, breathing with a ventilator, and intravenous medicine

You can download templates for this form from the Advance Care Plan website.

As part of an advance care plan you can appoint someone to make decisions on your behalf. This is known as ‘power of attorney'.

They can also take care of your personal finances, property and other assets should you become too ill to do it yourself.  There is more information about this on the government’s website.

You can nominate a next of kin, a close friend or a solicitor to do this. It's a good idea to consider the following:

• If you have named someone to have a Lasting Power of Attorney remember to write down who they are and keep a copy of this note somewhere safe
• If you have written down your wishes keep a copy of this document somewhere safe, and give copies to the people who need to know such as a nurse, doctor, carer or family member

England and Wales have slightly different procedures for setting up a power of attorney to Scotland and Northern Ireland. There’s a detailed guide with advice for how to do this in all four regions on the Which? website.

If you haven’t appointed someone to make decisions on your behalf and you become too unwell to make decisions, healthcare professionals will make a decision based on what they think is best for you.