Description of the legal term Living Will:
A living will, known formally in England and Wales as an Advance Decision to Refuse Treatment (ADRT), is a legal document that individuals use to outline their healthcare preferences in the event that they become incapacitated and unable to communicate their wishes. This can include decisions such as refusing certain medical treatments or procedures. The importance of a living will lies in the control it grants a person over their future healthcare and the clarity it provides to healthcare professionals and family members regarding their wishes.
Under the Mental Capacity Act 2005, an ADRT is legally binding in England and Wales, provided it meets certain requirements. To be valid, it must be specific about the treatments to be refused and the circumstances in which the refusal will apply. It must also be signed and witnessed, and the person making it must be competent and not under any undue influence at the time of creation.
The document only comes into effect when the individual has lost capacity to consent to or refuse the specified treatment. It cannot be used to request assistance in dying, as this is illegal in the UK. Healthcare professionals are legally bound to follow a valid and applicable living will, unless they have reasonable grounds to believe that circumstances have changed significantly since it was written.
Moreover, if a person has appointed a Lasting Power of Attorney (LPA) for Health and Welfare, the living will takes precedence in matters concerning treatment refusal. Healthcare providers, alongside the appointed attorney, must take the living will into account when making decisions about the person’s care.
Living wills are particularly important for those with progressive illnesses who wish to assert control over their future care or those with strong convictions about certain medical treatments. By creating a living will, individuals ensure that their beliefs and wishes are respected, thus relieving family members from making difficult decisions about their care.
Legal context in which the term Living Will may be used:
Consider a person suffering from an advanced form of dementia who was once a prominent campaigner for the right to refuse life-sustaining treatments. Before the onset of the disease, they drafted a living will, stating their refusal of artificial respiration should they become incapable of breathing independently. As their condition deteriorates, they are admitted to the hospital and eventually require respiratory support. Doctors, aware of the living will, meet with the family to discuss the situation. The document is reviewed, and it specifically covers the scenario at hand, making it clear that the individual had no wish for such intervention. Despite the emotional difficulty, the healthcare team and family understand that they must respect these stipulated wishes, and they agree to prioritize palliative care.
In another scenario, a young individual involved in a motorbike accident is left with severe brain damage. Prior to the accident, knowing the risks inherent in their lifestyle, they drafted a living will, specifically refusing dialysis should they ever develop a condition requiring such treatment. However, the accident leads to a different situation, where temporary dialysis is needed as part of their treatment plan but is not directly related to their accident injuries. The doctors determine that the living will does not cover this specific scenario. Therefore, after discussion with the family, it is decided to proceed with the dialysis as it is not in conflict with the explicit terms of the living will.
The existence of a living will plays a crucial role in upholding personal autonomy within the realm of UK healthcare. It allows individuals to have a say in their treatment when they are no longer able to voice their decisions, thus ensuring that medical care aligns with their values and wishes. It also helps to avoid potentially distressing situations where family members or medical staff must make decisions without guidance. For these reasons, living wills are invaluable instruments in the British legal and healthcare systems, empowering individuals to maintain their agency even when they are most vulnerable.