03 Sep Living Wills (Advance Directives)
On the Isle of Man, you can’t give someone else the power to make healthcare decisions for you when you have lost the capacity to do so. So, instead, we can choose to make a separate medical Advance Directive which is also popularly known as a “Living Will”.
An Advance Directive is a simple document that sets out your wishes in the event that you lose capacity to deal with your health and welfare. It is like a Power of Attorney for healthcare issues.
Under Manx Law these are not 100% legally binding, but the Manx Attorney General thinks that Advance Directives ought to be generally valid in Manx law. In any event, an Advance Directive is definitely going to be helpful and also quite persuasive if any dispute were to arise between your family and health care providers.
Advance Directives are there in case you can’t communicate what you want. Most people decide to make them to help their family decide what’s best for them and if there’s any doubt, clarify what they want.
We advise you to consult with a qualified medical professional in the event that you decide to make an Advance Directive, so that they can talk you through the issues that might arise or that you might not have thought about. It is useful to ask about potential treatment regimes and do-not-resuscitate processes with them as well. You do not have to seek medical advice to make an Advance Directive, but we can arrange this for you at Unity Legal as part of the process, if you would like a medical consultation.
What does an Advance Directive look like?
When you write an Advance Directive, you’ll be asked to consider a few different scenarios and queries to help you make the right decisions about what should happen to you if you become unwell without capacity.
If you choose to: you can nominate a person or persons, typically family members, who should be consulted first in the event that a decision needs to be made for example about where you live, or what healthcare you should have.
Consider someone who you know share your views and values about life and medical decisions. They should:
- Be a trusted family member or friend, lawyer, someone in your social or spiritual community
- Not be your doctor or a part of your medical care team
- Be willing and able to discuss medical care and end-of-life issues with you
- Be trusted to make decisions that adhere to your wishes and values
- Be trusted to be your advocate if there are disagreements about your care
The decisions your proxy makes
You can decide how much authority your proxy has over your medical care— whether they can make whatever decision is needed, or a few specific ones. Think carefully about whether you want a restriction like that in your Advance Directive. Sometimes, for financial or medical reasons for example, even if you do not want to go into a nursing home, that may be the best choice for you.
Make sure your proxy knows about it! Check with those you choose before you name them officially. Make sure they are comfortable with this responsibility.
What does an Advance Directive cover?
Life threatening conditions
In the event that you contract a condition where recovery looks uncertain, in some cases doctors have a range of decisions that could be made involving medication, life support, pro-active intervention such as surgery or other procedures. It can be helpful for you to indicate whether you would wish to be kept alive as long as possible, despite a grave prognosis, or whether you merely wish to be kept comfortable and pain-free without further invasive intervention.
If you should become gravely injured or contract a condition whereby you are mentally incapacitated but otherwise well, for example, a central nervous condition, brain injury or damage, or Alzheimers or dementia, you may wish for your life to be extended as long as possible regardless of whether you are aware of what is happening, or not. Alternatively, you may wish purely to be kept pain-free and comfortable.
Similar to those cases above, if there is a reduced or nil chance you will recover from a coma or other unconsciousness, you may not wish to receive active or intervention-based life support. Alternatively you may wish that every effort is made to keep you alive in case of recovery.
Particular medical treatments
You can specify which sort of treatments you prefer, definitely do not want, or would rather not have. Think about the following categories of potential treatment and (i) if, (ii), when, and (iii) how long you would want this sort of treatment for.
Cardiopulmonary resuscitation (CPR)
This restarts the heart when it has stopped beating. CPR or similar device involves delivery of an electric shock to stimulate the heart.
This takes over your breathing if you’re unable to breathe on your own.
This is required for most medical treatments and supplies the body with nutrients and fluids intravenously or via a tube in the stomach.
A common process, this removes waste from your blood and manages fluid levels if your kidneys no longer function.
Antibiotics or antiviral medications can be used to treat many infections. If you were near the end of life, would you want infections to be treated aggressively or would you rather let infections run their course?
Palliative or end-of-life care
This could cover any number of interventions that may be used to keep you comfortable and pain free while considering your other treatment choices. This may include being allowed to die at home, getting pain medications, being fed ice chips to soothe mouth dryness, and avoiding more invasive tests or treatments.
Organ and tissue donations
Something to consider: would you want particular organs or tissue to be donated, with the exclusion of some others? You can also consider donating your body for scientific study.
DNR (Do Not Resuscitate)
If you stop breathing and your heart stops, you’ll often need cardiopulmonary resuscitation which most of us know as CPR. It involves mechanically pushing on the chest to restore your breathing process and to get the blood flowing around your body again. It does often require a strong level of force on the chest whilst putting air in the lungs, and can sometimes cause broken ribs, bruising or collapsed lungs.
However, CPR is the first port of call for most emergency situations and if you are otherwise healthy your heart may start beating again. On the other hand, older and more frail people may not have such a good chance and the risk might not be worth it.
At the moment, on the Isle of Man if you do not have a DNR, your doctors will always seek to resuscitate you, so now is a good time to consider if that’s what you want. It can be part of your Advance Directive and it should always be on your record with your GP as well.
Once you have decided upon the provisions of your Advance Directive, we’ll draw it up and then you’ll need to sign and witness it. The original should be safely stored in the event that it is needed. We’ll make certified copies for you to keep in the event that you or your family needs
Remember, Unity Legal offers a year’s free storage in our Lawyer’s Safe and thereafter by arrangement for the life of the document.
Once you’ve safely stored the originals in an easily accessible place, here’s our advice for the next steps:
- Give a copy to your GP
- Talk to your family about the decisions you’ve made in your Advance Directive: do they know what you’d want for yourself if they had to make that decision for you? It might not be an easy conversation, but having it now means your family are less likely to make the wrong decision under pressure in a difficult time.
- Carry a card in your wallet, phone case, bag, etc which alerts people to your Advance Directive.
- Keep it with you when you are out and about, and especially when traveling.
Reviewing your Advance Directive and making changes
You can change your Advance Directive at any time, as long as you still have legal capacity to do so. If you want to change it, just call us and we’ll make the amendments you need.
You’ll need to make a new one altogether so that it takes the place of your old one otherwise the documents will conflict with one another and could undo all your hard work. It’s important to make sure that all old copies are destroyed and you’ve updated your family and your GP.
It’s a good idea to review your Advance Directive roughly every 10 years but some circumstances might crop up earlier than that such as:
- A new medical diagnosis, or
- Change of marital or family status
Email firstname.lastname@example.org or call 07624 35 60 45 and ask for Eric for a free, no obligation chat about your Advance Directive.