Regulating doctors, ensuring good medical practice

End of life care: Formalising a patient's wishes

60. If a patient wants to nominate someone to make decisions on their behalf if they lose capacity, or if they want to make an advance refusal of a particular treatment, you should explain that there may be ways to formalise these wishes, such as appointing an attorney or making a written advance decision or directive.23 You should support a patient who has decided to take these steps. You should provide advice on the clinical issues and recommend that they get independent advice on how to formalise their wishes.ix

 

Footnote

23 The Mental Capacity Act 2005 (MCA) and the Adults Within Incapacity (Scotland) Act 2000 legislation make provision for adults to grant powers of attorney to make healthcare decisions. Northern Ireland proposes similar legislation. The MCA sets out statutory requirements for making advance refusals of life-prolonging treatments. See the legal annex.

 

References

ixAdvice for doctors and patients about making formal records of advance refusals of treatment is available from the Advance Decisions to Refuse Treatment website; the Office of the Public Guardian (England and Wales) and in Scotland; and the Mental Welfare Commission for Scotland (pdf). Many patient support organisations also provide advice. The BMA has published guidance for doctors in Advance decisions and proxy decision making in medical treatment and research (2007).

 

 

Download the guidance