Advance decisions, welfare attorneys and statements of wishes: The belt, braces and corset approach to advance care planning

Abstract

Advance care planning is used by adults to express value-based preferences for informing future care and treatment decisions following their loss of decision-making capacity. It is a means for ascertaining previous preferences about types of care and treatment as well as wider concerns. In English law, advance care planning incorporates advance decisions to refuse treatment, statements of wishes and, more recently, the appointment of attorneys who act under the authority of a Lasting Power of Attorney for health and welfare. This article considers these mechanisms together with some of their merits and potential shortcomings. It also considers whether other approaches, such as advance consent, might be a useful addition. Ultimately, it argues that used in isolation the current options are insufficient on legal and pragmatic grounds, albeit for different reasons. For persons with a strong sense of their personal treatment and care preferences following their loss of decision-making capacity, a combined and synergistic approach is recommended.