Before you are ever ill or injured, decide three things: who should make decisions about your care if you cannot, what treatments you would and would not want, and what quality of life means to you. Then put those answers where they count, in a lasting power of attorney and, if you want one, an advance decision.
Why it matters
Hospital dramas show doctors fighting to save someone who arrives unconscious. Real life is less dramatic and more common: a stroke, a fall, a sudden illness, and suddenly you cannot speak for yourself.
When that happens, doctors make decisions in what they judge to be your best interests. They will consult the people close to you, but in England and Wales your family has no legal power to decide on your behalf unless you have given it to them. Some families cope well with that. Others disagree with each other, or with the doctors, at the worst possible time.
Question 1: who do you want to make decisions for you?
Think about who you would trust to make decisions about your treatment and care, and who would cope with the responsibility. It need not be the person closest to you; it should be the person who would carry out your wishes rather than their own.
A health and welfare lasting power of attorney makes that choice legal. You can name one person or several, and decide whether they must act together or can act separately.
Question 2: do you understand the treatments that keep people alive?
Resuscitation, ventilation, artificial nutrition and hydration: each has benefits, burdens and limits. Many people hold firm views on them only once they understand what they involve. Your GP can explain them, and so can the information published by the NHS.
If there is treatment you would refuse in specific circumstances, an advance decision records that refusal. If it is valid and applies to the situation, it is legally binding.
Question 3: what does quality of life mean to you?
For one person it is being able to recognise their family. For another it is independence, or being free of pain, or being at home. There is no right answer, only yours. Writing it down, in an advance statement or a letter to the people you have named, gives them something to steer by.
Three things to do
- Name your decision-makers in a health and welfare lasting power of attorney.
- Record any refusals of treatment in an advance decision, if you have them.
- Share your beliefs and wishes with the people you have named, so they are never guessing.