To hydrate or not to hydrate that is the question?

Should you give food and water to a dying man? The simple answer is yes. But life isn't always simple. If you are dying then your desire for both is likely to be serverly diminished. As I blogged the other day newspapers have been full of headlines of elderly relatives been left by hospitals without food or water.
      If you look on the Internet there seems to be quite a lot of debate on whether or not to provide food and water to the dying. Particularly if it has to be administered by artificial means. For most if us we think of using a knife and fork when we eat and a glass to drink. We don't think of a tube placed through your nose and throat or directly into your stomach.
      Not nice to consider.  Don't most of us want a say on how we should be treated if the time ever comes?
     Living Wills or Advance decisions were big news a few years ago but have since retreated into the shadows. I set out below some notes I've prepared on what making an advance decision involves.
     You don't need to put your wishes in writing unless you want to refuse life saving treatment. An important thing not to forget.
     As always this is general advice. You should take specific advice on your circumstances before acting

Making and Advance Decision - "Living will"

 

 

1.       An advance decision is a written statement which states what medical treatment is not to be carried out or continued if you lose mental capacity.  It does not form part of your will and is a totally separate document to it.  It applies during your life whereas your will only comes into effect on your death.

Mental capacity means the ability to understand the affect of your decisions.  Can a person:

1.1     understand and make sense of what is being said to them

1.2     making a rational decision based on what they have been told

1.3     express or otherwise communicate that decision.

2.         An advance decision won’t apply where:

 2.1       Un-specified treatment

The advance decision must specify what medical treatment is not to be carried out.  It will only apply to specified treatments.  You can make a statement in general terms so long as your intention and wishes are clear.

 2.2     Absent circumstances

Any circumstances specified in the advance decision are absent.

2.3     Un-anticipated circumstances

There are reasonable grounds for believing that circumstances exist which you didn’t anticipate at the time of making the advance decision and which would have affected your decision had you anticipated them e.g. medical advances

 

2.4       No declaration as to life saving treatment

The advance decision won’t apply to life saving treatment unless it contains a specific statement that it is to apply even if life is at risk

 

2.5      It conflicts with a Personal Welfare Lasting Power of Attorney

The advanced decision will become invalid if you later create a Personal Welfare Lasting Power of Attorney which would confer authority on the Attorney to give or refuse consent to the treatment to which the advance decision relates.

3.       Cancelling an advance decision

You can do this at anytime in whole or part.  Any cancellation does not need to be in writing

 

4.         What an advance decision cannot do

You are not permitted to:

 

4.1     Refuse basic nursing care essential to keep a person comfortable, such as washing, bathing and mouth care

 4.2     Refuse the offer of food or drink by mouth

 4.3     Refuse the use of measures solely designed to maintain comfort - for example, painkillers

 4.4     Demand treatment that a healthcare team considers inappropriate

 4.5     Ask for anything that is against the law such as euthanasia or assisting someone in taking their own life.

 5.         Making an advance decision known

Close relatives should be informed of the existence of such a document and its whereabouts. In the event of you being admitted to hospital for any life threatening illness then it is important that its contents are made known to the Doctors and Nurses who are treating you.  We recommend before finalising the Advance decision you discuss its contents and implications with your GP.

 6.         Other formalities

6.1.    The advance statement must be in writing. If you want to refuse life saving treatement

6.2.    The person making the statement must sign it and have their signature witnessed.  The witness must sign in the presence of the person making the statement.

 7.         Review your advance decision regularly

You should keep the advance decision under regular review to make sure it still covers your circumstances and doesn’t otherwise become invalid due to any of the grounds set out at paragraph 2 above.