Page 2 - Guide to Advance Directives

GUIDE TO ADVANCE DIRECTIVES – OFTEN KNOWN AS “LIVING WILLS”.

It has long been recognized in Scotland that an adult with legal capacity has the right to influence his or her
medical treatment. This includes the right to refuse to accept medical treatment at all if the adult so wishes.
Some people refuse certain treatments due to religious beliefs. More commonly nowadays people refuse
certain treatments because of possible side effects or because they believe coping with the illness may be
easier than accepting significant treatments which may have limited chances of success.

Of course being able to refuse treatment presupposes the patient has the ability to communicate. Legal and
practical difficulties arise where a person loses capacity, cannot communicate and therefore cannot
influence his or her treatment or refuse it. Medical advances have moved this issue to the centre stage
particularly towards the end of life. Now life can be sustained much longer than in the past even if the
patient is unconscious, with no hope of cure, and when death may occur at any time. Not everybody wants
to be kept alive for long periods in that condition by interventionist treatment. Just to give two examples –
someone extremely ill and very close to death might have a heart attack which would end their life, but
resuscitation could stop that natural death. Another example might be someone again in the very last stages
of life contracting influenza, which could be treated, but if left to take its course might result in an earlier
natural death. The problem is that the patient who is in the last stages of life anyway – is usually not able to
communicate his or her wish to refuse such treatment. The Advance Directive (AD for short) gets over that
problem by the patient stating his or her treatment preferences in writing and in advance to his or her
doctors and carers or relatives – in other words to the people who will be making medical decisions in these
last days.

This is absolutely not anything to do with assisted dying. It is not about having a car crash and your heart
stops and not being resuscitated. People should have absolutely no fears that an Advance Directive would
stop them getting any appropriate lifesaving treatment in the above or any other scenario.

An Advance Directive is simply a clear statement in advance to someone’s doctors and relatives as to their
wishes regarding healthcare and treatment should certain extreme conditions arise. These are if the person
was suffering from a terminal condition, was incapable of communication and understanding and also had
only a short time to live. At that point the medical professionals would really like to know what the person’s
wishes as to treatment were, and they would follow them. Consequently the existence of a Directive really
helps medical staff treating the patient towards the end of life.

The purpose of an Advance Directive is to prepare in advance a guide or direction or instruction to doctors as
to healthcare treatment someone would want in these extreme circumstances. A Directive can say anything
anyone wants it to say but most people choose to direct the doctors not to use intervention treatments
simply to prolong life a little longer – when letting things take their natural course might result in

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