A "living will" — properly called an Advance Decision to Refuse Treatment (ADRT) in England and Wales — lets you record in advance the medical treatments you would refuse if you became unable to communicate your wishes. It is not a will in the inheritance sense; it controls medical decisions while you're alive but unable to make them. This guide covers what an advance decision is, how it differs from a will and from an LPA, when it is legally binding, and how to make one properly.
Key takeaways:
- In England and Wales, "living will" is the informal name for an Advance Decision to Refuse Treatment under the Mental Capacity Act 2005.
- An advance decision only refuses treatments; it cannot demand any treatment.
- To refuse life-sustaining treatment, the document must be in writing, signed, witnessed, and explicitly state it applies "even if life is at risk".
- An advance decision is legally binding on doctors if valid and applicable to the situation that arises.
- A Health & Welfare LPA can cover similar ground more flexibly, by appointing attorneys to make decisions for you. Many people benefit from both.
What an advance decision actually is
An Advance Decision to Refuse Treatment (ADRT) is a statement you make in advance, while you have mental capacity, recording specific medical treatments you would refuse if you later lost capacity to communicate the refusal yourself.
It's governed by sections 24-26 of the Mental Capacity Act 2005. The Act gives an advance decision the same legal weight as a contemporaneous refusal of treatment by a capacitous patient. Doctors are bound to follow a valid advance decision in the same way they would respect a refusal made face-to-face.
The informal term "living will" is widely used but technically misleading — it implies a connection to wills under the Wills Act 1837, which deal with inheritance after death. The two are entirely separate.
What an advance decision can do
You can refuse:
- Specific named treatments (e.g. cardiopulmonary resuscitation, antibiotics, blood transfusion, mechanical ventilation)
- Whole categories of treatment in specific circumstances (e.g. "no treatment intended to prolong life if I am in a persistent vegetative state")
- Treatment in specific scenarios (e.g. "no life-sustaining treatment if I have advanced dementia and am unable to recognise my immediate family")
The refusal can be conditional — applying only in specified circumstances — or unconditional, applying whenever the named treatment might be offered.
What an advance decision cannot do
An advance decision is one-sided. It can only refuse treatments. It cannot:
- Demand any treatment (no patient has the right to demand specific treatment from the NHS)
- Refuse basic care like food, drink, warmth, hygiene
- Override clinical judgement about treatment that's clearly in your best interests where you haven't expressly refused it
- Cover euthanasia or assisted dying (illegal in the UK)
- Cover non-medical decisions (where you live, finances, social care) — those need a Health & Welfare LPA
The strict rules for refusing life-sustaining treatment
If you want your advance decision to apply to life-sustaining treatment (treatment without which you would die), the rules are stricter:
- The advance decision must be in writing.
- It must be signed by you (or by someone in your presence and at your direction).
- It must be witnessed by one adult (witness must also sign).
- It must contain an explicit, unambiguous statement that the refusal applies "even if my life is at risk" (or equivalent wording).
Without all four, a doctor will treat to preserve life even if the document refuses the treatment. The wording matters — vague language like "I wouldn't want extraordinary measures" is not enough.
How an advance decision differs from an LPA
| | Advance decision | Health & Welfare LPA |
|---|---|---|
| What it does | Records your decisions yourself in advance | Names a person (attorney) to make decisions on your behalf |
| What you can do | Only refuse specified treatments | Can make any health/welfare decision (within best-interests framework) |
| Flexibility | Fixed at the time you wrote it | Attorneys can respond to circumstances you didn't anticipate |
| When it applies | When you've lost capacity to refuse the named treatment | When you've lost capacity to make the decision |
| Registration | Not registered | Must be registered with the OPG before use |
| Cost | Free (you can write it yourself) | £82 OPG registration fee + preparation cost |
The two can work together. If you have both, the order of priority depends on timing:
- An LPA made after an advance decision and giving attorneys explicit authority over the relevant decision will override the advance decision (because you've effectively delegated the decision).
- An advance decision made after an LPA, or where the LPA doesn't cover the relevant decision, will override the attorney.
In practice, most people benefit from having both: an LPA for general health-and-welfare decisions you can't predict, and an advance decision for specific treatments you have firm views on (often resuscitation, ventilation, artificial nutrition).
When an advance decision becomes invalid or inapplicable
A valid advance decision can still be inapplicable if:
- You have done something inconsistent with it since making it (e.g. accepting a treatment you previously refused, or expressing changed views)
- Circumstances have changed in ways you didn't foresee, and the doctor reasonably concludes you wouldn't have refused if you'd known
- The specific treatment offered isn't the one you refused
- You've made a more recent LPA giving attorneys authority over the decision
Review your advance decision every few years and after any major change in your health or circumstances.
Trusted Hands focuses on wills and LPA preparation packs. We don't currently offer an advance decision document, but we recommend looking at the NHS England template (compassionindying.org.uk has a free, well-respected one). Start your LPA → — most people pair an LPA with their advance decision.
How to make one
You can write an advance decision yourself. The recommended steps:
- Talk to your GP about your medical situation, prognosis, and the realistic scenarios you might face. They can help you understand the treatments involved.
- Use a recognised template rather than free-form writing. Compassion in Dying (compassionindying.org.uk) and Marie Curie both publish free, well-drafted templates that meet the Mental Capacity Act formalities.
- Sign and witness it correctly, paying special attention to the life-sustaining treatment clause if you want it to apply.
- Tell people: your GP, your family, anyone named in your LPAs. Add a note to your medical record. A copy in a drawer no one knows about will not be followed.
- Review every few years, especially after major health changes or new diagnoses.
Frequently asked questions
Is an advance decision the same as a "do not resuscitate" (DNAR) form?
Different but overlapping. A DNAR/DNACPR is a clinical document signed by a doctor recording that CPR will not be attempted. An advance decision is a patient document recording the patient's refusal of treatment in advance. A valid advance decision refusing CPR is legally binding on the clinical team; a DNAR is the team's clinical decision (ideally in discussion with patient or family).
Is an advance decision the same as an advance statement?
No. An advance statement is a non-binding record of your preferences and values — what matters to you, what you'd like to happen if possible. Doctors should take it into account but are not bound by it. An advance decision is legally binding for refusals of specified treatments.
Can I just write down my wishes informally?
You can — but it may not be followed. Informal notes are taken as evidence of your views in best-interests decisions but lack the legal weight of a properly made advance decision. For life-sustaining treatment refusals specifically, the strict formalities (writing, signature, witness, "even if life at risk" clause) are essential.
Can I refuse all treatment?
You can refuse any specified treatments, even ones intended to save your life, if the formalities are met. You cannot refuse basic care (food, water by mouth, hygiene). You can refuse artificial nutrition and hydration (delivered by tube), which is treated as a treatment.
What if my family disagrees with my advance decision?
A valid advance decision is binding on doctors regardless of family views. Family members can raise concerns, and if there is genuine doubt about validity or applicability the matter can go to the Court of Protection — but the starting position is that your advance decision is followed.
Does an advance decision cover mental health treatment?
Yes, for refusing specific treatments. There is a notable exception under the Mental Health Act 1983: if you are detained under that Act, certain treatments for the mental disorder can be given without consent (sections 58-63), and an advance decision refusing them does not necessarily override the Act. Take advice if this is your specific concern.
How is an advance decision different from a will?
A will (under the Wills Act 1837) deals with your money, property and dependants after you die. An advance decision deals with medical treatment while you're alive but unable to communicate. The two have nothing to do with each other legally despite the shared "will" word.
Trusted Hands is a UK will-writing and LPA preparation service, not a firm of solicitors and not a clinician. The information above is general; advance decisions involve medical and ethical considerations that benefit from discussion with your GP and (for the document drafting) a charity like Compassion in Dying that specialises in this area.
Sort your LPAs to pair with your advance decision
A Health & Welfare LPA is the natural partner to an advance decision — your attorneys can handle the dozens of decisions you can't anticipate.
- £99 for a single LPA (Property & Financial OR Health & Welfare)
- £179 for both LPAs (single person)
- 25% off when bundled with a will