Advance Decisions (Living Wills)

The Mental Capacity Act 2005 (which became law on 1 October 2007) now provides the legal framework for advance decisions (formerly, an “advance decision” was called a “living will” or an “advance directive”). These documents allow competent adults to state the type of medical care they would like to receive if they are no longer able to actively participate in such discussions. (It should be noted that the Mental Capacity Act 2005 only applies to England and Wales: Scotland introduced a similar Act in 2000).

Initially introduced in the United States in the 1960s, as “living wills”, about 600,00 individuals in this country now have completed these forms. At present, in the UK, the main organizations providing advance decision documents are Dignity in Dying (formerly the Voluntary Euthanasia Society), in London, and Friends At the End, in Glasgow (for further information, please see the “Resources” section elsewhere on this website). It is advisable that an individual’s GP is a witness to that person’s signature on an advance decision: also, these documents should be updated every three to four years.

The Secular Medical Forum fully supports the use of advance decisions, and recommends that everybody (especially health care professionals, who can set an example) completes one, because, at some future date, this document could be extremely important for the family, friends, and the personal doctors and nurses looking after each of us.

The Forum wants to stress that if a patient is treated contrary to the wishes clearly expressed in an advance decision then this is likely to be considered either as a “civil trespass” or even as a “criminal assault”.

In the past, when a typical living will simply stated that someone refused, under certain conditions, life-prolonging treatment, these documents could be easily criticized as “suicidally motivated refusals of medical treatment” (as in a letter which appeared in The Daily Telegraph on 1 April 1998 from the Roman Catholic leaders of England, Ireland, Scotland and Wales). Today, advance decisions are essentially “pro-choice” documents because they can be used equally well to record that someone wants medical treatment to be given to prolong life, for as long as one’s doctor considers advisable, as much as declaring, as previously, that medical interventions which sustain life are refused.

Advance decisions are fully endorsed by the British Medical Association, the General Medical Council, the Law Society, and the Royal College of Nursing.

In addition to giving legal support for advance decisions, it should be noted that the Mental Capacity Act 2005 also deals with other practical choices that have to be made on behalf of people who cannot make some decisions for themselves (eg: financial decisions, choices about where to live or about how someone is to be cared for).