Age and Ageing Advance Access originally published online on January 13, 2006
Age and Ageing 2006 35(2):116-121; doi:10.1093/ageing/afj035
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Living wills and the Mental Capacity Act: a postal questionnaire survey of UK geriatricians
1 Department of Ageing and Health, 9th Floor North Wing, St Thomas’ Hospital, London SE1 7EH, UK
2 Hathaway House, Popes Drive, London N3 1QF, UK
3 Department of Elderly Care, Charing Cross Hospital, London W6 8RF, UK
4 Brighton & Sussex Medical School, Royal Sussex County Hospital, Brighton, East Sussex BN2 5BE, UK
5 Care of the Elderly, Imperial College, Hammersmith Hospital, London W12 ONN, UK
Address correspondence to: R. Schiff. Email: rebekah.schiff{at}gstt.nhs.uk
Objective: to determine geriatricians’ experience of and views on living wills, National Health Service Trusts’ support of advance end-of-life health care planning and geriatricians’ views on related legal changes in the Mental Capacity Act.
Design: anonymous postal questionnaire survey of all 1,426 British Geriatrics Society members in England, Wales and Northern Ireland.
Results: a total of 842 (59%) questionnaires were returned. Of 811 geriatricians, 454 (56%) had cared for patients with living wills. Of the 280 who cared for patients when the living will had come into effect, 108 (39%) had changed treatment because of the living will and 84 (78%) of those felt that decisions had been easier to make. Living wills not already in effect made discussions with patients [171 of 178 (96%)] and families [135 of 178 (76%)] easier. Of 779 geriatricians, 713 (92%) saw advantages of older people using living wills; 467 of these also expressed concerns. Only 16 (2%) geriatricians who had concerns said that there were no advantages. A total of 214 (27%) were aware that their Trust had a form to help with discussions about cardiopulmonary resuscitation. Fewer [126 of 781 (16%)] were aware of a Trust policy on living wills. The proposal, in the Mental Capacity Bill, for advance refusals of treatment was supported by 59% (476 of 801), yet the proposal for a lasting power of attorney (LPA) covering health care was only supported by 47% (382 of 806).
Conclusion: many geriatricians have positive experiences of caring for patients with living wills. Despite recognising potential problems, most geriatricians support the use of living wills by older people. However, most believe that their Trust does not have a policy to support advance health care planning. Geriatricians have reservations about LPAs covering health care.
Keywords: living wills, Mental Capacity Bill, older people, advance health care planning, elderly
Received June 22, 2005; accepted in revised form November 29, 2005.
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