Advance directives: questionnaire survey of NHS trusts.

An advance directive gives patients the legal right to give or withhold consent to specific medical treatments prospectively. This provides them with some reassurance about the dying process being managed in accordance with their wishes. Apprehension could be further allayed if it were known that the legal status of advance directives was consistently applied across the NHS. Guidance on advance statements about medical treatment was initially published by the BMA in 1995. The legally binding status of advance directives was reiterated by Luttrell in 1996. Nevertheless, in 1998 a survey of 214 general practitioners found that only 49% were aware that advance directives carry legal force. In 1999 the NHS Executive issued guidance on withholding consent to treatment and the General Medical Council issued guidance on the current legal position on advance directives. It remains unclear how NHS trusts have responded to this guidance and to what extent people can expect that their advance directive would be respected if they were an NHS patient who was dying. We carried out a survey to discover what provision trusts have made to recognise advance directives through actual or intended development of policies.