Only half of GPs in study knew that advance directives could carry legal force in UK

Editor—Zaman and Battcock are right: doctors need to know more about advance directives.¹ We hope that our paper will help them.² Like Zaman and Battcock, we conducted a postal survey, surveying all 270 general practitioners who refer patients to our hospitals in Hampshire and London; 214 (79%) replied. Of these, only 104 (49%) were aware that there were circumstances under which advance directives currently carried legal force in the United Kingdom.

A further six questions answered by these 104 doctors showed that most did not know important aspects of the law in relation to advance directives. For example, 13 thought that doctors were legally obliged to give all treatment that was requested in a valid directive, and only 44 knew that they were obliged to withhold treatment that was refused; only 15 were aware that the nomination of relatives or friends as proxy decision makers does not carry any legal force. Only one respondent answered all six supplementary questions correctly.

Zaman and Battcock are not strictly correct when they state that advance directives are invalid in the case of patients receiving treatment under the Mental Health Act. These directives may still be valid provided that the treatment to which they refer is not covered by the terms of the patient’s detention under the act.³ This precedent was set in the Sidaway case, when the right of a schizophrenic patient to refuse leg amputation was upheld even though he had been detained under the act.⁴