What do these words mean ?

mike stone 21/03/12 Dignity Champions forum

I attach 2 things; one is the collected replies to a question I emailed to many Dignity Champions, and the other is a recent piece of guidance for End-of-Life (as in 'about a year to live') or elderly patients/people (Planning for your future care: a guide, published by the National End of Life Care Programme, ISBN: 978 1 908874 01 6, publication date: Feb 2012).

That piece of guidance discusses Advance Decisions to refuse treatment, and on page 7 it uses this wording, which is intended to be guidance for patients:

'Sometimes you may want to refuse a treatment in some circumstances but not others. If so, you must specify all the circumstances in which you want to refuse this particular treatment.'


Does that say, that when refusing a treatment by means of an Advance Decision, you must ALWAYS specify BOTH the treatment being refused, and also the circumstance sin which your refusal is to apply ?

Or, does it say you have the 2 OPTIONS of EITHER simply saying 'I refuse treatment X', OR of saying 'I refuse treatment X if ..... is the situation' ?

I have become aware that some people interpret those words one way, and I interpret them a different way.

Please note, I do not primarily want to know what anybody has been taught about Advance Decisions, here - I specifically wish to know, whether if you simply read those words, you would believe that it were possible to validly write as the instruction on an Advance Decision 'I refuse X.' (where X is the treatment being refused - for example 'any transfusion of blood products of human origin') without including any circumstances ?

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mike stone 21/03/12

I am not certain if the 2 files are going to attach - I have never done this before and the message on screen is confusing me somewhat: if they won't attach, I will try to attach them again in the future, Mike

mike stone 02/04/12

This is Mike Stone again. I have recently assembled a long PDF (attached, I hope) which has within it 3 different surveys covering:

1) Certain issues I examined under 'The Rules for Death'

2) That 'what do those words mean ?' thing

3) A suggestion, in a paper by Iona Heath (President RCGP) that perhaps for CPR, it should be changed from opt-out to opt-in

It also includes some of my own analyses, covering amongst other issues:

Must an Advance Decision include circumstances, or can it simply say 'I refuse 'specified treatment'.

Is it true, as some SHAs are writing, that an Advance Decision is legally binding if it refuses future CPR, but a verbal refusal of future CPR is not legally binding.

SORRY ABOUT THE LACK OF AN INDEX - THE PDF IS more of a draft version, than a publication.

Best wishes, Mike Stone

PS My e-mail address is in there - if you wish to discuss any of the points/issues I raise by e-mail, contact me.

I have also attached my own attempt to condense the principles for CPR decision-making into 4 pages - I would appreciate any comments, about whether it is easier to follow and understand than current clinical guidance tends to be ?

Associated files and links:

mike stone 02/04/12

Not sure if the long PDF attached - here goes, another attempt to attach it, Mike

Associated files and links: