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In April 2007, the Mental Capacity Act will come into force. One aspect of the Act is to codify legislation on Advance Directives.

New terminology will be introduced – Advance Decisions for specific advance refusal of treatment and Advance Statements, a more generic statement about preferences and values. The Act, in combination with NHS initiatives to improve end of life care generally, including the promotion of advance care planning, makes it likely that geriatricians will be seeing more patients with Advance Decisions and/or Advance Statements.

Whilst the BGS has acknowledged that Advance Decisions have a role in helping determine best interests when an individual no longer has capacity, there are some concerns about the evidence base underpinning the use of Advance Decisions. The current literature is dominated by the North American experience – can this evidence be translated to the UK? What are the optimal settings in which to introduce Advance Decision discussions – hospital or community, before or after illness? Does the health care proxy’s views correlate with the views of the individual?

Geriatricians frequently care for individuals likely to lose capacity and in whom end of life discussions are relevant. In view of the importance of this issue to the Society, the BGS Clinical Practice and Effectiveness Committee sought to take the lead on the development of a set of robust evidence based guidelines for clinicians on advance decisions and advance statements. BGS UKMC has agreed to support this process.

A multidisciplinary group comprising members of CPEC, the BGS SIG for Medical Ethics, the BGS Nurse Consultants’ SIG, Help the Aged, Age Concern, the Alzheimer’s Society, the Royal College of Nursing, the Royal College of General Practitioners and the Faculty of Old Age Psychiatry has been assembled.

The plans for the development of the guidelines have been reviewed by the Clinical Evaluation and Effectiveness Unit at the Royal College of Physicians and are based upon SIGN methodology. In essence a literature review will be undertaken, a consensus conference will be held, the multi-disciplinary group will then assemble the guidelines and then publish and disseminate them. The next challenge will be to implement them and monitor the effect of doing so.

The guideline development started in September 2006 and the final guidelines should be available in March 2008. Any members interested in finding out more about the guidelines or who wish to participate are invited to email me through the editor - a link to whom is at the top of this page.

Simon Conroy