Advance directives occupy an important place in the debate about the limits of patient autonomy, the right to refuse life–saving medical treatment and euthanasia. In February 1994, the House of Lords Select Committee on Medical Ethics strongly endorsed the use of advance directives as a way of enabling patients to express in advance their individual preferences and priorities for medical treatment in the event that they should subsequently become incompetent. The Committee felt that the preparation of advance directives could often stimulate healthy dialogue between doctor and patient about health care choices, assist health carers in decisions about appropriate treatment and provide secure knowledge for patients that their wishes have been properly documented.

With advance directives entering the public domain in increasing numbers and the recommendation by, amongst others, the Law Commission for legislation to define and regulate their use the legal and ethical debate over the effect, use, limitations and general desirability of advance directives continues to intensify. This chapter attempts to examine the present status of advance directives in English law and explore a number of the important legal and ethical questions to which they give rise.

THE NATURE AND FORM OF ADVANCE DIRECTIVES

An advance directive is essentially a stipulation made by a competent person about the medical treatment he should or should not receive in the event of his becoming incompetent to make or communicate treatment choices.