Advance Care Planning Options

An Advance Statement is a way to record what matters to you, including your wishes, preferences, beliefs and values about future care.

It can cover where you would like to be cared for, what makes life worth living for you, and anything you would want others to know if you could no longer tell them yourself.

Important to know: an Advance Statement is not legally binding, but anyone making decisions for you must take it into account when deciding what is in your best interests.

• NHS: Advance statements about your care wishes

Also known as a Living Will.

An Advance Decision lets you refuse specific medical treatments in the future, in case you become unable to make or communicate those decisions yourself. You must be 18 or over and have capacity when you make it.

Important to know: an Advance Decision is legally binding if it is valid and applies to the treatment and circumstances at the time. You can refuse treatment that might keep you alive, but extra requirements apply: it must be written down, signed and witnessed, and state that the refusal applies even if your life is at risk. A later Lasting Power of Attorney that gives your attorney authority over the same treatment can override it.

• NHS: Advance decisions (Living Wills)

An LPA lets you choose someone you trust to make decisions about your health and care if you become unable to make those decisions yourself.

Your attorney must act in your best interests, taking account of your wishes, beliefs and values.

Important to know: an LPA must be registered before it can be used, and your attorney can only act for you when you lack capacity to make a particular decision. You decide whether your attorney has authority to make decisions about life-sustaining treatment, so it is important to make that choice deliberately when you set it up.

• GOV.UK: Make and register an LPA
• Office of the Public Guardian
• GOV.UK: Guidance for attorneys

ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment.

It is a process that helps you and your healthcare professionals talk through and record recommendations about your care and treatment in a future emergency, particularly if you cannot communicate or make decisions at the time.

Important to know: a ReSPECT form is a clinical recommendation, not a legally binding Advance Decision. It can include recommendations about CPR and other emergency treatments. It is used widely but not in every area.

• Resuscitation Council UK: ReSPECT for patients and carers
• Resuscitation Council UK: about ReSPECT

A Treatment Escalation Plan records discussions and clinical recommendations about which treatments may or may not be appropriate if your health gets worse.

This might include whether going into hospital, intensive care or other treatments would be helpful, taking account of your health, wishes and priorities.

Important to know: a TEP is not a legally binding refusal of treatment. It helps healthcare professionals plan appropriate care and should be discussed with you wherever possible. Names and forms vary between areas. One example of a local plan is the NHS Somerset Treatment Escalation Plan (STEP/eSTEP).

DNACPR stands for Do Not Attempt Cardiopulmonary Resuscitation.

It means that if your heart or breathing stops, CPR will not be attempted. A DNACPR decision may record your own decision to refuse CPR, or a clinical judgement that CPR would not work or would not be appropriate for you.

Important to know: a DNACPR decision only relates to CPR. It does not mean other appropriate treatment or care will be withheld. The form itself is not legally binding, but a valid Advance Decision refusing CPR is, and if you have capacity your own refusal of CPR must be respected. You have the right to be informed and involved in decisions about CPR, unless this would cause you harm.

• NHS: DNACPR decisions