Expressing wishes for end of life

The choices that should or should not be legally available to someone suffering a terminal illness are back in the spotlight. MSP Margo MacDonald continues her campaign to give terminally ill people in Scotland the right to choose when to die.

Implementation of a living will is quite different from voluntary euthanasia. A living will calls for inaction on the part of clinicians. Euthanasia requires someone to take an active role.

The term “living will” is a misnomer. A living will has nothing to do with what happens to property upon death, and is better described in this country as an advance medical directive.

Every adult with mental capacity has the right to agree to or refuse medical treatment. When you are ill, you can usually discuss treatment options with your doctor and then jointly reach a decision about your future care.

But what happens if you are unconscious or unable to make your own decisions about your treatment or communicate your wishes? What happens if, for example, you are suffering from mental illness? If you are deemed to be incapable of making an informed decision for yourself, doctors have a legal and ethical obligation to act in your best interests.

A living will is a way of planning for this eventuality. It is an expression of your wishes set out in advance of illness at a time when you have the mental capacity to understand the issues involved. It sets out clear instructions and is used to outline circumstances in which you would like medical treatment withheld – for example if you suffer from a terminal illness or a serious incurable physical illness.

This is obviously a difficult area, but if it is one that you wish to consider then it is important to seek legal advice and to consult your GP and family. This is particularly the case in Scotland where such documents do not yet enjoy the legal status that they do in England and Wales.

This makes it even more important that you have properly outlined your wishes to your doctor, that the document is shared with your doctor, and that any physicians treating you can then be informed and ensure your views are taken into consideration along with your medical notes.

The document should also demonstrate clearly your attitude to ill health and disabilities, and make plain your understanding of them, to guide all those involved in your future care.

Many years can pass between the drafting the document and the point at which it might be required. It may be helpful to update the document through letters reaffirming that the wishes the document contains remain those held by you.

Finally, it is important to remember that we can also change our mind. In that case, the living will should be withdrawn and destroyed, and all those consulted in its preparation should be informed of the change of mind.

If you would like to discuss any of the issues raised in this article, please get in touch with Paul Roper on 01835 862 391 or email