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11th October 2015

Advance Care Directives

In Scotland, people receiving health and social care can make advance directives. These are statements of how they would want their future care to be provided, in the event that they become unable to make choices and decisions for themselves. It is a useful and sensible step for people who think they may lose this capacity to decide for themselves in the future. The Adults with Incapacity (Scotland) Act 2000 states that when providing care and support to people who have incapacity, account must be taken of the previous and present wishes of the person. This principle allows the previous properly recorded and witnessed statements of the person to be used as evidence of their past wishes.

Making an Advance Directive

In England and other parts of the UK, legislation and arrangements for these statements are different, but the principles are broadly similar.

People who are considering making these directives are advised:

  • To take legal advice, and advice from their health and care teams;
  • To have their statements written down, dated and properly witnessed;
  • To have the directive available for use if required;
  • To have the directive regularly reviewed as part of their overall care.

What does it cover?

It can include how you want your health care to be provided, including whether and in what circumstances you wish to accept or refuse medication or food, even where the refusal may be life-threatening; it can state your wishes about whether you should be resuscitated in the event of heart failure (with a separate form and procedures to be implemented for this); how and where you wish your health care to be provided.

Can it be over-ridden?

In some circumstances, yes.  If you did not have capacity when you made the directive, it can be over-ridden: if new treatments, unavailable when the directive was made, become available, this may change the weight health professionals give to your previous wishes; or if you have given powers of welfare attorney to a specified person, then this may lead to a reconsideration of your treatment.

Advantages

The directive will provide security to you about how you can control your future treatment, even though you may lose you decision making ability; it can minimise any conflict which may arise with your carers for family; and it can provide clarity to health care staff to ensure you receive the appropriate care in your circumstances. Organisations which provide end of life support, such as NHS and Macmillan's, support this advance care planning , and provide further advice on it on their websites.

*All information is correct at the time of publishing

Tony Clarke

Scottish Care Inspectorate Specialist

Tony began care work as a care assistant in care of the elderly here in Scotland in the 1970s. He very much enjoyed promoting activities, interests and good basic care.After a gap to gain a social work qualification, he worked in management of care services, latterly as a peripatetic manager which gave him experience of a wide range of services. Read more

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