Making an Advance Directive for an Elderly Parent in Scotland

The conversation nobody wants to have: sitting down with your mum or dad and asking them what they want to happen if they can't speak for themselves. The impulse is to put it off — they seem fine, there's no rush, it feels morbid.

Then a stroke hits, or dementia progresses past the point of meaningful conversation, and you're left guessing what they would have wanted while clinicians ask for decisions you're not legally authorised to make.

Why Timing Is Everything

An advance directive in Scotland can only be created by someone who has decision-making capacity at the time of signing. That means they can understand the information relevant to the decision, retain it long enough to weigh it, and communicate their choice.

Early-stage dementia doesn't automatically mean someone lacks capacity — capacity is decision-specific under the Adults with Incapacity (Scotland) Act 2000. A parent with mild cognitive impairment may still have full capacity to decide they don't want to be resuscitated or to refuse artificial nutrition in a vegetative state. But that window closes, and once it does, the advance directive route is permanently off the table.

The alternative — guardianship through the Sheriff Court — can exceed £2,000, takes months, and gives a court-appointed guardian less flexibility than a welfare attorney would have had. Timing the advance directive and welfare POA setup before capacity deteriorates is the single most valuable thing a family can do.

Having the Conversation

Start with what your parent has already seen or experienced. Many older adults have watched friends or neighbours go through prolonged hospital stays, and they have strong opinions about what they would and wouldn't accept — they've just never been asked to write those opinions down.

Frame it practically rather than emotionally: "If something happened and you couldn't tell the doctors what you wanted, how would we know what to do? Let's write it down so the hospital follows your wishes instead of guessing."

Topics to cover: Would they want CPR if their heart stopped? What about being put on a ventilator? How do they feel about a feeding tube if they can no longer eat? What would they want if they were diagnosed with advanced dementia — would they still want active treatment for infections, or would they prefer comfort care only?

Don't try to cover everything in one sitting. Spread it across two or three conversations. The goal is their genuine preferences, not a document drafted under pressure.

The GP's Role in Palliative Planning

If your parent is already receiving palliative or end-of-life care — through a hospice, a community nursing team, or a specialist consultant — the clinical team can facilitate the advance directive conversation as part of anticipatory care planning (ACP).

In NHS Scotland, ACP is a structured process where clinicians help patients document their care preferences. The GP or palliative care team can simultaneously complete a ReSPECT form (Recommended Summary Plan for Emergency Care and Treatment) or a DNACPR order, which gives the Scottish Ambulance Service immediate guidance in an emergency.

The advance directive and ReSPECT form serve different but complementary purposes. The directive is a legal document recording your parent's treatment refusals. The ReSPECT form is a clinical recommendation from the medical team about what emergency interventions are appropriate. Having both, and ensuring both are uploaded to the Key Information Summary (KIS), gives the most complete coverage.

What You Can and Cannot Do as Their Child

You cannot make an advance directive on behalf of your parent. Only the individual themselves can execute the document — that's a fundamental principle of Scots common law. Your role is to facilitate the conversation, help with the practical drafting, and ensure the final document gets to the GP and onto the KIS.

If your parent wants you to make healthcare decisions on their behalf when they can no longer do so, they need to appoint you as their welfare attorney through a formal power of attorney registered with the OPG Scotland. An advance directive alone doesn't give you any decision-making authority — it records their decisions, not yours.

If capacity is already gone and no welfare POA was registered, neither route is available. A family member may need to apply to the Sheriff Court for a welfare guardianship order. That gives the guardian authority to make the decisions covered by the order, but it does not create the same written record of your parent's treatment refusals that an advance directive would have provided.

Practical Steps

1. Start the conversation — use their existing experiences and opinions as the entry point
2. Draft the directive together — specific treatment refusals under named clinical scenarios, with the sanctity-of-life clause
3. Arrange witnessing — an independent adult who is not a spouse, civil partner, blood relative, or named attorney
4. Book a GP appointment — scan the directive, flag the clinical alert, upload to KIS
5. Consider a welfare POA — appoint an attorney while capacity exists, register with OPG Scotland (£99 fee, current processing ~46 business days electronically)

Our Scotland Advance Directive toolkit provides the clinical wording templates, witnessing checklist, and GP request letter that make this process manageable — especially when the conversation itself is the hardest part.

See more Scotland guides →