Advance Directives and Anticipatory Care Planning in Scotland

When your parent is diagnosed with dementia, one of the most difficult but important conversations is about what happens as their condition progresses. Anticipatory care planning gives your parent a voice in future medical decisions — while they still have the capacity to express their wishes.

Anticipatory Care Planning

An Anticipatory Care Plan (ACP) is a structured conversation between your parent, their GP, and their family about future care preferences. It is not a single document but an ongoing process that is recorded in your parent's medical notes and shared with relevant healthcare professionals.

The ACP typically covers:

• Preferences for where your parent wants to be cared for (home, care home, hospital)
• Views on specific medical treatments (antibiotics for infections, hospital admission for acute illness)
• Wishes about resuscitation
• Important personal values and priorities
• Named contacts for healthcare decisions

Scotland uses the Key Information Summary (KIS) — an electronic record that GP practices can share with out-of-hours services and hospitals. Getting your parent's ACP recorded on the KIS means their preferences are accessible in an emergency, even at 3 am when their regular GP is not available.

Advance Directives

An advance directive (sometimes called a "living will") is a written statement setting out your parent's wishes about specific medical treatments they do or do not want in the future. In Scotland, advance directives are recognized in common law and by NHS Scotland policy, though they are not governed by specific legislation as they are in England and Wales.

An advance directive is most effective when it is specific. A general statement like "I do not want to be kept alive artificially" is harder for doctors to interpret than "I do not want cardiopulmonary resuscitation if my dementia has progressed to the point where I no longer recognize my family."

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)

A DNACPR decision is a clinical decision made by a doctor, ideally in discussion with your parent (if they have capacity) and the family. It is recorded on a purple DNACPR form and placed in your parent's medical notes.

A DNACPR is not an advance directive — it is a medical recommendation that CPR would not be successful or would not be in the patient's best interests. However, your parent's wishes expressed through an ACP or advance directive should inform the clinician's decision.

If a DNACPR is placed on your parent's record and the family disagrees, you have the right to request a second medical opinion and to escalate through the hospital or health board's complaints procedure.

Section 47 Certificates

For ongoing medical treatment of a parent who lacks capacity, doctors can use Section 47 of the Adults with Incapacity (Scotland) Act 2000 to authorize treatment. A Section 47 Certificate of Incapacity is valid for up to one year, or up to three years if the incapacity results from severe dementia.

Section 47 authorizes medical treatment only — it cannot be used to authorize moves to a care home, detention, or forced restraint except where immediately necessary to prevent serious harm.

Why This Matters for Dementia

Dementia is progressive. The conversations that feel premature today become impossible in 18 months. Helping your parent document their preferences while they can still participate is one of the most meaningful things you can do.

Our Scotland Dementia Care Guide includes templates for recording care preferences and a checklist for the anticipatory care planning conversation.

See more Scotland guides →