Free Advance Decision Template
Making an Advance Decision to Refuse Treatment allows you to state your healthcare preferences for the future; our downloadable template makes it easier to get started on this important document.
Understanding Advance Decisions
An Advance Decision, sometimes called a “Living Will,” is a written statement of your wishes regarding future medical treatment. It comes into play if you can’t make or communicate decisions for yourself. Here’s what you should know:
- Clarity Is Key: An Advance Decision is legally binding if it’s clear, specific, and informed. It details the treatments you want to refuse and under what circumstances.
- A Personal Declaration: It reflects your autonomy, allowing you to take control of your healthcare decisions ahead of time.
- Legally Recognized: While laws vary by region, many countries honor these documents within their healthcare systems.
Why Consider an Advance Decision?
The thought of future incapacitation isn’t pleasant, but being prepared can ease the burden on both you and your loved ones.
Peace of Mind
Knowing that your wishes will be respected can provide significant comfort.
It relieves your family from making tough decisions during emotional times.
Doctors can provide care more efficiently when they know your wishes.
Creating Your Advance Decision
Creating an ADRT doesn’t have to be daunting. Here’s a simple breakdown to get you started:
- Reflect on Your Wishes: Consider the types of treatments you would or wouldn’t want. Think about various scenarios and what would be most important to you.
- Discuss with Healthcare Professionals: Consult your doctor to understand the implications of refusing certain treatments.
- Put It in Writing: Draft your Advance Decision, being as specific as possible about treatments and circumstances.
- Make It Legal: Depending on your location, you may need to meet certain requirements, like witnessing or notarizing your document.
Communicating Your Decision
Once created, your Advance Decision should not be kept a secret.
- Inform Your Family: Share your decisions with your loved ones so they’re not caught off-guard.
- Tell Your Healthcare Team: Ensure your primary care physician has a copy and understands your wishes.
- Keep It Accessible: Store your ADRT somewhere easily accessible and consider registering it if your country has a registry.
When to Review Your Advance Decision
Life changes and so might your views on treatment. Regularly reviewing your ADRT is crucial:
- After Any Major Life Event: Such as marriage, divorce, or the birth of a child.
- If Your Health Changes: New diagnoses or changes in your condition might affect your decisions.
- Every Few Years: Even without significant changes, it’s good practice to review your ADRT periodically.
Using the Advance Decision Template: A Step-by-Step Guide
Step 1: Personal Information
Start by filling out your personal details. Write your full legal name where you see
[NAME], ensuring it matches the name on your identification documents. Next, enter your date of birth in the format day, month, then year
[DATE OF BIRTH]. Lastly, provide your complete residential address, including any specifics like apartment number
Step 2: Statement of Intent and Declaration of Capacity
Read the ‘Statement of Intent’ to understand the purpose of the document. Confirm your understanding and agreement. Under ‘Declaration of Capacity,’ verify that you are over 18 years old and are creating this Advance Decision voluntarily. Acknowledge that you comprehend the implications of refusing medical treatments by proceeding.
Step 3: Specific Refusals of Treatment
In this section, you need to specify the medical treatments you wish to refuse. Carefully consider each scenario presented and indicate your choices clearly. For instance, in the event of a persistent vegetative state, you may refuse certain life-sustaining treatments like mechanical ventilation. Be as clear and specific as possible to ensure your wishes are understood.
Step 4: Power of Attorney
If you have designated a Health Care Power of Attorney, mention their name and confirm that their role is to uphold the instructions laid out in this Advance Decision. If you haven’t appointed one and wish to do so, you’ll need to complete separate legal documentation for that.
Step 5: Validity and Revocation
Understand that the Advance Decision will remain valid indefinitely unless you decide to revoke it. Acknowledge that revocation must be done in writing should you choose to change your Advance Decision in the future.
Step 6: Legal Protection for Health Care Providers
By signing the document, you acknowledge and agree that no healthcare provider will be held liable for following your directives as specified in this Advance Decision.
Step 7: Signatures
Once all parts of the Advance Decision are completed to your satisfaction, sign your name where it reads
Signed by [NAME]. Fill in the date next to your signature.
Step 8: Witness Declaration
Have a witness present for the signing of your Advance Decision. The witness must then fill out their name, address, and the date, confirming that you are of sound mind and signed the document voluntarily. The witness should then sign under the ‘Witness Signature’ section to validate the document.
By following these steps and providing clear, concise information, you’ll create a valid Advance Decision that reflects your medical treatment preferences.