Towards the end of life you might want to make some decisions about your care, including any instructions for refusing treatment.
Advance care planning
Your doctors and nurses might talk to you about advance care planning.
This means making decisions about how you would like to be cared for if you become too ill to communicate your wishes in the future.
The doctor or nurse will write down your wishes. You can let them know at any time if these change. And you can include your family and friends in the discussions with your doctors and nurses if you want to.
You can also write requests about your care in a living will. Living wills are sometimes called advanced directives. Your doctor or nurse might ask you to make decisions about some of the issues below.
It can sometimes be very difficult to know what care and treatment to have when you are near the end of life.
There are many medicines that can help to control symptoms and keep you comfortable. Your doctors and specialist nurses can advise you on the best medicines for your situation.
Some people feel so tired and weak that they don’t want to have medicines that could extend their life. For example, someone who gets a severe infection could choose not to have antibiotics, even if they know that without them they will die very soon.
In the UK, as an adult you can legally refuse medical care and treatment if you don't want to have it. Doctors can only give you treatment and medicines with your permission. You can set out your instructions about treatments you would like and which your don't want in a legal document called an advance decision.
Doctors should explain what happens if you refuse the medicines, and support you if you decide that you don't want the treatment.
It can sometimes be very hard for your family and friends to accept that you don’t want any further treatment. You could ask your doctor or nurse to talk to your family and explain how you feel, if this is a problem for you.
Make sure that you talk to your medical team about any symptoms or problems that you have. Find out what treatment is available. You might feel differently about treatment if your pain and other symptoms can be relieved.
When you have a terminal illness, your doctors may explain that they won't try to restart your heart and lungs if they stop working. Trying to restart them is called cardiopulmonary resuscitation (CPR).
Of course, it might be very upsetting for you and your family to hear this. But your doctors are saying this because trying to start your heart and lungs again won't work if you are very ill with advanced cancer.
You also have the right to refuse CPR.
You can discuss your views about CPR with your healthcare team. You can tell them whether or not you want them to try it.
The doctors take your wishes into account, but you can’t insist on having CPR. Your healthcare team can decide not to try it if they think it won’t work.
Your doctors write the decision in your medical notes. That way, everyone looking after you is aware of it. You can ask for a second opinion with a different doctor if you want to discuss the decision further.
The Resuscitation Council UK website has more information about resuscitation and your rights.
Treating an infection
You might get an infection if you are very ill and nearing the last few weeks of your life.
So you might want to talk to your doctor and loved ones about whether you would want to have antibiotics if you got an infection.
Your doctor can note your wishes in your medical notes. You can change your mind later if you want to.