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Heart failure - chronic - Management
What information can I give to people with end-stage heart failure about advance decisions?

  • Advance decisions (also called advance directives or living wills):
    • Allow the person to specify (before they have lost the capacity to decide) what treatments they would not want and would not consent to.
    • Cannot demand treatments.
    • Must be respected by clinicians.
    • Can be withdrawn if the person regains capacity.
    • Can be made verbally, except for decisions that refuse life-sustaining treatment (such as artificial ventilation), which must be written, signed, and witnessed.
    • Cannot refuse basic care, such as the provision of warmth, shelter, and hygiene. This includes food for eating and water for drinking, but not artificial nutrition and hydration.
  • Clinicians are responsible for finding out if a valid advance decision exists.
  • An advance refusal of treatment is binding if:
    • The person making the advance decision was at least 18 years of age, and had the necessary mental capacity.
    • It specifies treatment to be refused, and the applicable circumstances.
    • It has not been withdrawn.
    • Nobody has subsequently been given power of attorney to make treatment decisions on the person's behalf.
    • The person making the advance decision has not subsequently given reason to believe that they have changed their mind.
  • The legal framework for advance decisions is provided by the Mental Capacity Act 2005, which also provides for resolution of disputes and disagreements about advance decisions.
  • The Mental Health Act 2007 introduced safeguards on the deprivation of liberty into the Mental Capacity Act 2005.

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