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The term advance directive (increasingly being replaced by the term advance decision) means a statement explaining what medical treatment the individual would not want in the future, should that individual 'lack capacity' as defined by the Mental Capacity Act 2005.

Advance directives are legal documents that provide instructions for medical care and only go into effect if you cannot communicate your own wishes. The two most common advance directives for health care are the living will and the durable power of attorney for health care.

It is a written statement of your wishes to refuse a certain treatment. It may also include the specific situation in which you wish to refuse the treatment. It is a way of making sure that everyone knows what treatment you do not want to have, if you become unable to make your own decisions in the future.

Types of Advance Directives The living will. Durable power of attorney for health care/Medical power of attorney. POLST (Physician Orders for Life-Sustaining Treatment) Do not resuscitate (DNR) orders. Organ and tissue donation.

There are two main elements in an advance directivea living will and a durable power of attorney for health care. There are also other documents that can supplement your advance directive. You can choose which documents to create, depending on how you want decisions to be made.

Limitations. Advance directives have limitations. For example, an older adult may not fully understand treatment options or recognize the consequences of certain choices in the future. Sometimes, people change their minds after expressing advance directives and forget to inform others.

If there is evidence to suggest the person has changed his or her mind for example, if they have done something that goes against the advance directivethis would make the advance directive invalid.

The qualitative analysis identified four barriers to ACP: 1) limited patients' participation in autonomous decision making, 2) cognitive and emotional barriers to discussion, 3) lack of readiness and awareness of early discussion, and 4) unprepared healthcare professionals and healthcare system.

The research identified six themes related to barriers to completing an advance directive: 1) provider time constraints; 2) education: patients, loved ones, and healthcare professionals; 3) a lack of comfort discussing end of life; 4) culture; 5) advance care planning evolvement; and 6) specialization by non-physicians

A further critical limitation of advance care plans is that even when they are documented, they are not accessible in practice, and where they are available, health care professionals and family members do not always follow the documented preferences.