Should advance directives have a statutory basis?

Who takes decisions concerning the medical treatment of adults when they can no longer decide for themselves because of mental incapacity? Such incapacity may be temporary, resulting for example from a toxic state; fluctuating in some cases of mental illness; or permanent as a result of severe dementia, severe learning disability, or the persistent vegetative state. Such patients may receive care in a wide range of settings, and their numbers are growing, particularly as a result of an aging population, emphasising the need for legal clarity for patients, their carers, and health professionals. Most doctors will at some time be faced with the care of such a patient and thus need to be aware of the implications for medical practice of proposed changes to the law.

In 1995 the Law Commission proposed that the legal provisions governing decisions on health, welfare, and financial affairs in cases of mental incapacity should be brought under a single statutory instrument.1 Last month the government issued a green paper seeking public …