This can be made with your medical team and is used to record your wishes around treatments and care.

You can include a range of information such as where you want to be cared for at the end of your life, who you want to be there, religious, and cultural beliefs, diet and daily routine. You can have an advanced care plan alongside other documents like a lasting power of attorney. 

You should make sure that it is easily accessible for medical teams looking after you. It can be written with a doctor or nurse, someone you trust or by yourself. 

There is no official documentation for an advanced care plan, but Hospice UK has produced a  Planning Ahead tool. This tool will help you to think about your values and the things that are most important to you in life (and in dying).

This differs from an advanced care plan as it can be used to refuse medical treatments, including lifesaving medicines.

You can refuse cardio-pulmonary resuscitation (CPR), air way support (ventilation), artificial feeding or antibiotics delivered using a drip. You cannot decline basic nursing care such as washing, and dressing and you must be clear about the situations to which your decision applies. 

A doctor can help explain treatments to you and make sure your decisions are recorded correctly. There is no official template for this, as long as the decisions are recorded clearly and signed by yourself and witness the document becomes legally binding and will be followed by your medical team. 

Therefore, it is important to make sure that those involved in your care and close family and friends have a copy. You can visit mydecisions.org.uk to generate an advance decision. If you are using the decision to refuse treatment, it will need to be signed at witnessed.The paperwork can be downloaded and printed or filled out online.

Capacity refers to having the mental capacity or capability to make decisions. Capacity is specific to the time of the decision and what the decision is.

Therefore, some people fluctuate in their capacity so that they may have capacity some days but not others. This is especially the case if they have an illness which may contribute to them becoming confused, for example a urine infection.

Some people have the capacity to make some decisions but not others. For example, they may have capacity to decide when they would like to get up and dressed in the morning but not about where they can safely live.

Capacity must be assumed; people who lack capacity must be assessed by a trained medical professional as unable to do one of the following things:

• - Understand the information needed to make the decisions
• - Retain that information long enough to use it in their decision.
• - Weigh up the information, the pros and cons of the decision.
• - Communicate their decision effectively.

If there is a situation where you lack capacity or are very unwell and unable to communicate your decisions, then the documents you used to record your wishes will be used.

You (the donor) can give lasting power of attorney to allow one of more recipients (attorneys) on health and wellbeing, property and financial affairs or both. This is a legal document which gives attorney’s permission to make decisions on your behalf when you are unable (lack capacity) to do so.

Lasting power of attorney can be used alongside an advance decision and if there is any disagreement the most recent document is the one used. Lasting power of attorney can make any decision regarding your health and welfare.

As a legal document the lasting power of attorney needs to involve you as the donor, attorney(s), a certificate provider (to demonstrate that you are not being pressured into your choice) and up to five people to be notified when the document is registered. It does not require a solicitor but must be registered with the Office of the Public Guardian which involves a fee. The decision can take 8-10 weeks to be implemented.

Differences in Scotland

Health and welfare is known simply as a welfare attorney. In Scotland you need to provide a written document with the names and addresses of your attorney(s) and any powers you would like them to have. You
must make a clear statement that you understand the powers of welfare and that you have considered capacity. Your signature must be witnessed, and that witness must then sign the document themselves. Power of attorney comes into force if you lack capacity.

A separate document regarding capacity must also be submitted. This is certificate that needs to be signed by a solicitor who is registered to practise law in Scotland or by a practising doctor in the UK to state that they are satisfied you understand the purpose of welfare power of attorney. That you understand the powers the attorney(s) would have and that you are not being pressured into giving them these powers.

The final documents together must be submitted to the Scottish courts and tribunal services which involves a fee.

Macmillan cancer care provide a free template for you document your understanding of your disease and priorities of care.

This is not a legal document but would be taken into account by a medical team. It is a space to document preferences and future end of life care, especially where you want to be cared for. 

This can be shared with people you trust such as family and friends, your GP or a hospital medical team.

Find out more about Macmillan.