Advance decisions

What you need to know about advance decisions and GPs’ obligations.

  • If a GP knows about an advance decision, it is their responsibility to record this in the patient's notes and share with the hospital team if appropriate.
  • There is no requirement that advance decisions must be discussed with a healthcare professional.
  • Advance decisions can be made verbally or in writing - unless the treatment is life-sustaining, which needs to be in writing, signed and witnessed.

What is an advance decision?

Advance decisions enable someone with capacity who is 18 years or over to refuse specific medical treatment for a time in the future when they lack capacity to refuse or consent to that particular treatment. Advance decisions are provided for on a statutory basis by the Mental Capacity Act 2005, but there is no corresponding legal right to demand specific treatment.

Patients may want to discuss advance decisions with their GP, and to know more about conditions they have or may have in the future and what treatment would involve. Healthcare professionals can explain what types of treatment may be vital and in what circumstances, and the implications and consequences of the patient refusing such treatment. However, there is no specific requirement that an advance decision must be discussed with a healthcare professional.

Advance decisions can be made verbally or in writing, although if that decision relates to the refusal of life-sustaining treatment, the decision needs to be in writing, signed and witnessed.

Patients who have previously made an advance decision may want to review it with their doctor from time to time and update it if necessary. Just because a decision was made a long time ago, it does not automatically render it invalid - but treating clinicians may want to question or confirm whether the decision is still the patient's continuing wish.

Read more in our guide on decision-making and consent.

GPs' responsibilities

If you're aware that a patient has made an advance decision, it's important to record this in the patient's notes. It is the responsibility of the person making the decision to tell you about it.

Encourage the patient to tell family members or close friends so they can inform healthcare professionals, for example, if the patient is admitted to hospital as an emergency and lacks capacity.

If a GP is aware of an advance decision, they should communicate this with the hospital team. GP records could be flagged so that the existence of an advance decision will be obvious when the notes are accessed.

When a patient is admitted to hospital and lacks capacity, it may not be possible to establish whether they have made an advance decision. Clinical management must be based on the patient's best interests. Family members may be aware of an advance decision and may have a written copy of this. If no copy is available, the patient's GP should be contacted to see whether they have any record of a decision in the patient's notes.

GPs who are aware a patient has been admitted to hospital and has made an advance decision have an obligation to ensure the treating clinicians are aware of this. Provide a written copy to avoid any misunderstandings.

The treating doctor and their team will decide whether the advance decision is still appropriate and valid and applicable in the circumstances. If there is any dispute, the treating team should consider getting advice from the trust's legal services department and the MDU.

This page was correct at publication on 14/02/2022. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.