Table 2

Advance care plans/processes

Advance care planLegal statusDescription
Advance decision to refuse treatment—England and Wales*Legally binding if valid and applicableState clearly, in specific circumstances, what treatments the person would not wish to receive, such as cardiopulmonary resuscitation, ventilatory support, antibiotics, gastrostomy/enteral feeding, hospitalisation.
Advance directive—Scotland*Not legally bindingThis allows someone to record treatments that they would want to decline in the event they lose capacity.
While not legally binding, it should be referred to where a decision needs to be made.
Lasting power of attorney for health and welfare decisions—England and Wales†
(referred to as welfare power of attorney in Scotland†)
Legally appointed roleThe person appoints another person/s to support decision-making around their health/welfare needs if they no longer have capacity to do so. The appointed attorney/attorneys can accept or decline treatments offered.
Note this role is distinct from lasting power of attorney for finance.
Independent mental capacity advocateIndependent roleAn independent mental capacity advocate is an advocate appointed to act on someone’s behalf if they lack capacity to make decisions and they have no family/friends to take part in best interests discussions.
Emergency healthcare plansAdvisory
Not legally binding
Personalised plans in case of a future ANTICIPATED emergency when the patient may be unable to make an informed decision.
ReSPECT process recommended by the Resuscitation Council UK.14
Many areas also used treatment escalation plans.
Advance statementAdvisory
Not legally binding
Sets out in general terms how the patient would like to be cared for.
It is a record the person’s wishes during the end of their life, including who they would like to be with, where they would like to be cared for, music, dietary needs, cultural or religious wishes and funeral plans.
Options for donation of tissue—brain bank.
These should still be taken into account when making decisions.
  • *No equivalent to the above in Northern Ireland.

  • †No equivalent in Northern Ireland. Power of attorney for finance can be appointed.

  • ReSPECT, Recommended Summary Plan for Emergency Care and Treatment.