Advance decisions

Your decision about your future care including whether you want life-saving treatment or to participate in research in the event that you lose mental capacity is governed by the Mental Capacity Act 2005.

If you wish to refuse medical treatment in the future you should make that known in the form of an ‘advance decision’. This is done when you still have mental capacity to make decisions and is used if you are unable to make a decision at the time of the proposed treatment.

If you are aged 18 or older and have mental capacity you can also appoint a health and welfare lasting power of attorney (LPA). Your attorney can make decisions on your behalf about future treatment if you lack the mental capacity to make that decision yourself. Your attorney cannot override an advance decision you have made unless the LPA was made on a later date and states that s/he has the power to do so.

If an advance decision is not made and an attorney has not been appointed, it might be possible if you care for someone that has lost mental capacity to apply to the Court of Protection to become a deputy.

In the event where none of the above is in place the Local Authority or the NHS will provide an Independent Mental Capacity Advocate (IMCA) to support and represent the individual.

An advance decision can be written or verbal, unless it deals with life-sustaining treatment, in which case it must be written and specific rules apply. The Mental Capacity Act Code of Practice outlines the information that is required when making an advance decision.

You cannot make an advance decision refusing actions necessary to keep you comfortable, such as warmth, shelter and hygiene.

The Mental Capacity Act safeguards people who lack capacity to consent to many types of research. The act advocates that the interests of the incapacitated person are more important than those of science and society as a whole. The act covers ways of consulting people about the research, evaluating and approving the safety of the research and the levels of risk and intrusion associated with the research.

You can get advance decision information from health and social care professionals (eg your GP, social worker). It is not essential that you use a special form, but it may be helpful. You can read more about advance decisions and access forms to complete at the following:

• Compassion in Dying is on 020 7479 7731
• NHS: Advance decision to refuse treatment
• The Natural Death Centre is on 0871 288 2098 or 
• AgeUK factsheet 72 – Advance decisions, advance statements and living wills