Advance Planning can include medical, practical, spiritual, cultural, emotional, legal, and financial matters. Ultimately, this is your opportunity to define what you want to happen when you die, what you don’t want, who will speak for you, and what you want to happen after you die. It involves: Identifying your wishes and preferences Refusing treatments in some circumstances Stating whether or not you want cardiopulmonary resuscitation Asking someone to speak for you by assigning a Proxy Spokesperson Appointing a Lasting Power of Attorney (LPA) to legally make decisions for you Recording and documenting / registering these decisions Informing people about your wishes An Advance Statement is your opportunity to record these wishes and preferences on a signed and dated document. While it is not legally binding, it can be considered during care planning if you have lost capacity to communicate. You can also nominate a proxy spokesperson to execute it. When writing your statement, consider your beliefs and values, who you would like to be consulted, any spiritual care, the care environment, any physical care including your senses and care of your body after death, any emotional care including how to manage your fears, any reassurances for the nominated decision maker, and any goals before you die.

An Advance Decision to Refuse Treatment (ADRT) gives your health and social care team clinical and legal instructions about your decision to refuse specific treatment in the future when you approach your end of life. It will only be used if you lose your ability to make your own decisions. Unlike an Advance Statement, your ADRT is a legally binding document. You must have mental capacity when you write it, and it must be signed and dated by you and a witness. Your ADRT must state that your advance decision applies even if your life is at risk, for example: “the following refusal of treatment will apply even if my life is at risk or may be shortened as a result.” You may want to refuse a treatment in some situations, but not others, so you need to be clear about all the circumstances in which you want to refuse treatment. There are also some areas you cannot use an ADRT for, such as asking for assisted death which is against the law in the UK. As this is a legally binding and crucially important document for your future, it is best to seek consultation with a clinician. Find out more about ADRTs at the NHS website.

A DNACPR decision is made in conjunction with a medical practitioner and asserts your decision to not be resuscitated in the event of a cardiac arrest. While not legally binding, it helps you to communicate to the healthcare professionals involved in your care that CPR shouldn’t be attempted, and while you may be consulted, your doctor has the final decision in some cases. There are some circumstances where this type of resuscitation can be so physically traumatic for the body, such as for a very elderly or frail person, that they would prefer to opt for DNACPR and accept their end of life at this point.

A Lasting Power of Attorney (LPA) gives another person the legal authority to make decisions on your behalf, should you lose mental capacity. This includes rights to make decisions about your property, financial affairs, healthcare, welfare, and medical treatment. You should appoint somebody who knows you well, who you can trust to act in your best interests, and who is reliable and has the skills for this responsibility. They should consider your past and present wishes, and they cannot take advantage of you to benefit themselves from this power. This includes keeping all of your money separate from their money. If you do not know somebody who you can trust in this capacity, you can appoint a solicitor instead. Your LPA will need to be registered with the Office of Public Guardian before it can be used. This costs £82 for each LPA registration. You can complete a form online at the Office of the Public Guardian (OPG). Visit https://www.lastingpowerofattorney.service.gov.uk/home or stationery shops that provide legal packs. Alternatively, you can consult a Lawyer or a Legal Advisor on End-of-Life Planning or Estate planning. If you don’t have an LPA, and later lack capacity to make decisions for yourself, someone may need to apply to the Court of Protection to become your deputy, so it is best to organise this early on in life when you are still physically and mentally able.

Nominate someone in advance of your death to provide information about your preferences when the time comes, so that all the plans you have made in advance are known and accessible to those who need to know. Give copies to relevant people: those closest to you, your doctor, anyone who will be contacted in an emergency, and any professionals involved in your care, and keep a copy easily accessible in your home. You can also carry a Notice of Advance Decision card on you, and consider wearing Medic Alert Jewellery.