Abstract
The Lord Chancellor has recently announced that he is considering implementing a Law Commission Report which recommends that advance directives, or living wills, made by patients should be given statutory force. This would codify the common law principle that a patient has an absolute right to refuse treatment, regardless of whether the treatment was necessary to save their life. An advance directive would also enable a patient to stipulate in advance that their treatment be terminated should they later succumb to a persistent vegetative state (PVS). Advance directives can serve as important subjective evidence of where the patient's best interests lie, and obviate many of the present legal and moral difficulties inherent in a situation where the best interests of a PVS patient must be determined by a doctor. However, little attention has been paid to the category of advance directive in which a patient insists on treatment which the medical profession regards as futile or disproportionately expensive. In the light of evidence that such insistence directives already have legal validity, we may anticipate an inevitable clash with issues of public policy and finite economic resources for healthcare.
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