Planning your care - Advance statements - How
How do I make an advance statement or advance decision?
You can tell someone your advance statement or advance decision. Or you can write it down. But if you want to make an advanced decision to refuse life-threatening treatment you will need to write is down. See ‘How do I make an advance decision to refuse life-sustaining treatment’ for more information.
You could tell a family member, friend or other professional such as your GP. A GP is likely to make a note of the conversation in your medical notes.
We recommend that you write your advance statement or advance decision down so that there is less question about your wishes in the future. It can still be helpful to speak to loved ones about what you have written in your advance statement or advance decision.
What do I put in my advance statement?
There is no set template that you need to use for an advance statement.
The types of things that you could include in your advance statement could be the following:
- Your treatment preference.
- Where you would like to be cared for. Such as your home, hospital or hospice.
- How you would like a religious or spiritual belief to be reflected in your care.
- How you like to do things. Such as if you prefer a bath or a shower.
- Things that you like. Such as a particular scent. Or if you prefer to be outside or inside. Or your favourite foods.
- Who you would like to look after your children or pets.
- Who you would like to deal with your benefits and bills.
- What happens when you become unwell.
Remember that your advance statement is not a legal document. If there is someone who you would like to look after your benefits and bills or make decisions about your care and treatment you should think about making a Lasting Power of Attorney.
Certain care or treatment that you would like may not be available in future. You can update your advance statement with any changes at any time.
Example of an advance statement:
Name: Jane Smith
Date of Birth: 01/04/1970
Address: 37 Cambridge Road DY7 8TP
I, Jane Smith, have been detained under the Mental Health Act 3 times to date. Whenever I am detained I tell mental health professionals not to tell my son and daughter information about my medication and care.
But I want my son and daughter to know what medication I am taking and what care I am being given. I also want them to be involved with planning my care on discharge. Even though I will tell professionals that I don’t want this to happen. When I become unwell I believe that my son, daughter and other loves ones are plotting against me. Don’t tell me that you have told
them my information. It will cause me distress.
Don’t give me medication through injection. I have always been scared of injections and this adds to my distress. If I will not accept oral medication on its own, put it into my food. I have a good appetite even when I am unwell. This will help me to build trust with staff and hopefully help me to get better quicker.
I also have an advance decision to refuse electroconvulsive therapy (ECT).
I have told my son and daughter that I have made an advance statement and advance decision and given them each a copy. I have also made my GP aware and given them a copy. I have added their contact details below.
GP: Doctor Foster
Address: Roper Way Surgery, DY7 4BJ
Contact number: 0121 478 1365
Daughter: Sharon Smith
Date of birth: 05/06/1990
Address: 37 Cambridge Road, DY7 8TP
Contact number: 07984731244
Son: Peter Smith
Date of birth: 25/02/1993
Address: 52 Birdcage way, CM4 3LY
Contact number: 07845123457
Signed: Jane Smith
Printed name: Jane Smith
Today’s date: 15th February 2017
What do I put in my advance decision?
There isn’t a set template to follow. But the Mental Health Act Code of Practice suggests that you include the following information.
- Your full name.
- Your date of birth.
- Your home address.
- Any distinguishing features you have such as a birth mark or tattoo. This can be helpful if healthcare professionals need to identify you if you are unconscious.
- The name and address of your GP.
- Whether or not your GP has a copy of your document.
- A statement that the document should be used if you ever lack capacity to make treatment decisions.
- A clear statement of your decision:
- the treatment to be refused, and
- the circumstances in which the decision will apply.
- The date the document was written or reviewed.
- Your signature.
- The date of signing.
- A signature from a witness.
There are specific rules that need to be followed if you would like to make an advance decision which refuses life sustaining treatment.
How do I make an advance decision to refuse life-sustaining treatment?
An advance decision to refuse treatment must state exactly what treatment you want to refuse. A general statement is not enough. Include as much information as you can.
An advance decision to refuse life sustaining treatment must meet certain criteria:
- they must be put in writing,
- you must sign the advance decision,
- you must sign it with a witness with you,
- the witness must sign the document when you are with them, and
- you must include a clear, specific written statement to state that the advance decision will apply to specific treatment even if your life is at risk.
You should discuss an advance decision to refuse life-sustaining treatment with your doctor. They will be able to explain:
- what kind of treatment may be life-sustaining,
- in what circumstances they will apply, and
- what could happen if you refuse the treatment.
You don’t need to get legal advice when you create an advance decision. But you can talk to a solicitor if you would like to. This is likely to cost you money.
Where do I keep my advance statement or advance decision?
Professionals need to know that you have an advance statement or advance decision. If they don’t know it exists they can’t use it.
You could tell people where to find your advance statement or decision. You could also give them their own copy or get your medical records updated. You could:
- tell your GP,
- tell your mental health team,
- update your NHS summary care records scheme (SRC),
- tell a friend or relative,
- wear a health alert bracelet,
- carry a crisis card, or
- update a health app on your phone.
What is the summary care records scheme (SCR)?
The SCR is an electronic record of important information about you. It is created from your GP medical records. It can be seen by certain staff in other areas of the health and care system to help with your care.
You will have a SCR already unless you have told the NHS you do not want one. As a minimum, it includes the following information about you:
- current medication,
- allergies and details of any previous bad reactions to medicines, and
- your name, address, date of birth and NHS number.
You can ask your GP to include information about your advance statement or advance decision on your SRC.
What is a crisis card or health alert bracelet?
You can carry a crisis card or wear a health alert bracelet which says you have an advance statement or advance decision. A health alert bracelet can be known as medical jewellery. It can help make sure that health professionals know you have one if you can’t tell them. They contain information about anything that you would like people to know such as who to contact if you are ill, your doctor’s details, diagnosis and your medication.
How do I update my advance statement or advance decision?
You should regularly review and update your advance statement and decision in writing, even if you don’t want to make any changes.
You can change your advance decision at any time, as long as you have capacity to do so.
Professionals only have to follow your advance decision if it is valid and applicable. A recent advance decision is more likely to be valid and applicable to you and your circumstances. This is because your views and circumstances may change over time. Decisions that you made a long time ago aren’t automatically invalid or inapplicable but it may raise doubts with professionals.
A good time to review your advance statement or decision could be at the following times:
- A new stage in your illness.
- The development of new treatments.
- A big change in your life.
If you change your mind about what it says, you could add information and attach it to your original statement. If you are making a lot of changes you could write a new statement or decision. You should destroy the original advance statement or decision and any copies so health professionals
don’t get them mixed up.
How do I end my advance statement or advance decision?
You can cancel your advance statement or advance decision at any time as long as you have mental capacity to do so. You can cancel in writing or verbally. There isn’t a formal process to follow. But you should tell anybody who knew about your advance statement or decision that you have decided to cancel it.
You should destroy the original advance statement or decision and any copies. Or clearly mark that you have changed your mind and they are no longer valid.
You can find more information about ‘Legal Advice’ here.
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