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9 Apr 2020

Coronavirus: should you make an advance care plan?

It has never been more important to have a plan in place for the type of treatment you want to receive at the end of life

It's certainly not easy to think about the final stages of life. Many of us do our best to avoid it most of the time. But with the current coronavirus crisis, it's never been more important to have a personalised care plan in place.If you're an older person or someone with underlying health problems, it's particularly crucial that your wishes are recorded.

The vast majority of people who catch coronavirus have a mild illness and make a full recovery. But it's still a good idea to plan for what could happen if you're less fortunate, especially if you are at higher risk because of age or complex health needs. Making plans for the end of life (called advance care planning) can make you feel more in control and confident that your wishes will be followed in the worst case scenario.

    What is a living will (or advance decision)?

    One important way of recording an end of life plan is with a 'living will', which is also called an advance decision to refuse treatment (ADRT) or an advance directive. It's a legally binding way to tell people about specific medical treatments you don't want to receive in the future. It will only be used if you can't communicate a decision for yourself. But if a health professional knows you've made an advance decision, they have to follow it.

    This could be important right now for people with health problems who are concerned about surviving the coronavirus with a poorer quality of life than they currently have. For instance, an advance decision could be used to refuse life-sustaining treatments, such as a being put on a ventilator if you can't breathe by yourself or being resuscitated if your heart stops.

    With the NHS under so much pressure currently, doctors may have to make difficult decisions about someone's care. But having an advance decision in place helps give healthcare professionals a clearer sense of your priorities and preferences.

    How to set up a living will

    It's worth talking to your GP or other health professionals involved in your care before you write an advance decision or living will. They'll be best placed to help you understand what it means to refuse certain treatments. It may also be a good idea to talk to a solicitor.

    You don't necessarily need to put an advance decision in writing, but the NHS strongly recommends you do. Guidelines suggest the letter includes:

    • Your full name, date of birth and address
    • Your GP's contact details
    • A clear explanation of the treatment you are refusing
    • A statement declaring the advance decision should be used if you lack the capacity to make your own decisions
    • A signature and a date
    • A witness signature (this is legally required if you are refusing life-sustaining treatments).

    Which? Wills can help you record your care wishes in a living will.

    What is a 'do not resuscitate' order?

    Living wills are often confused with 'do not attempt resuscitation' (DNAR) decisions (which used to be called 'do not resuscitate' (DNR) orders).

    A DNAR tells healthcare professions whether or not they should attempt an emergency procedure to bring you back to life if your heart stops beating or you stop breathing. Only a doctor can make a DNAR decision. But this should be done in consultation with you or people close to you.

    A doctor is only ever likely to recommend a DNAR decision if they feel that resuscitation is unlikely to be successful or may even cause you harm.

    While you can't make a DNAR decision yourself, you can request that your doctor issues one. And if you don't want to receive CPR or other emergency treatments, you can state this on your living will which would be legally-binding.

    Record your care priorities with an advance statement

    Another way of recording your wishes is an advance statement. This isn't a legal document like a living will, but an advance statement allows you to record your preferences for how you would like to be cared for. This can include any information that's important to you such as:

    • Where you want to be cared for and where you want to die.
    • Who you want to be with you near the end of life.
    • Beliefs and values, such as your religious belief.
    • Dietary requirements.

    Although an advance statement is not legally binding, anyone involved in your care must take it into account. It also means the people close to you don't have to second guess what you would want.

    There isn't a specific form for an advance statement. You can simply tell your family, carers or health professionals. But it is a good idea to put it in writing. You can draw up your own document or look online to find a template, such as this NHS example. You can also find advance statement templates from charities such as Compassion in Dyingand Dementia UK. While it doesn't need to be signed or witnessed, it's better if it is signed and dated so people can be confident it represents your most up-to-date wishes.

    Make or update your will

    Making a will lets you decide what happens to your money, property and possessions after you die. If you don't have one, it can take longer to sort out your affairs.

    You may already have a will, but if not, this is a good time to make one. If you do have one, check it's still up to date.

    Think about funeral plans

    You can record any funeral preferences you have as part of an advance statement or in a separate funeral plan.

    Even though it's a tough topic to bring up, it's a good idea to talk to loved ones about your preferences too if you feel able to. This will make it easier for them to plan the funeral you would have wanted.

    Consider Power of Attorney

    A Lasting Power of Attorney (LPA) lets you give someone you trust the legal authority to make decisions on your behalf if in future you're no longer able to make decisions or communicate them for yourself.

    An LPA can cover decisions about medical treatment, care and living arrangements but also decisions about your finances and your property.

    Stay up to date with all the latest coronavirus news and advice from Which?