Ethics review Living wills and intensive care – an overview of the American experience.docVIP

Available online /content/11/4/219 Review Ethics review: ‘Living wills’ and intensive care – an overview of the American experience Andrew RJ Tillyard Specialist Registrar, Intensive Care Department, Royal Cornwall Hospital, Truro TR1 5LJ, UK Corresponding author: Andrew RJ Tillyard, arjtillyard@ Published: 11 July 2007 Critical Care 2007, 11:219 (doi:10.1186/cc5945) This article is online at /content/11/4/219 ? 2007 BioMed Central Ltd Abstract The 2005 Mental Capacity Act allows a competent person aged over 18 to make an AD that pre-emptively states their treatment preferences or to appoint a lasting power of attorney (LPA) to make decisions for them, if they become incapacitated. There is no set format for an AD (it can be written or verbal) unless it is specifically pertaining to refusing life-sustaining treatment, where it must be written and counter-signed. There is no obligation to seek advice from medical professionals when drawing up an AD, and it can be revoked verbally. If valid to the clinical scenario, an AD will override a LPA if one exists. The LPA must act in the patient’s best interests, must be registered with the Office of Public Guardian, and the document must be structured in a statutory form that is counter-signed by an independent third party. The LPA can refuse life-sustaining treatment if it is explicitly stated in the patient’s draft, is counter-signed and is deemed to be Withdrawal and limitation of life support in the intensive care unit is common, although how this decision is reached can be varied and arbitrary. Inevitably, the patient is unable to participate in this discussion because their capacity is limited by the nature of the illness and the effects of its treatment. Physicians often discuss these decisions with relatives in an attempt to respect the patient’s wishes despite evidence suggesting that t