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What is a Living Will? (And How It Works With Your Will)

· 14 min

Note: The following scenario is fictional and used for illustration.

Margaret, 68, a retired teacher from Cardiff, suffered a severe stroke that left her on life support. She'd told her daughter many times over Sunday dinners, "I'd never want to be kept alive on machines." But without a legally binding advance decision, doctors couldn't follow the family's wishes.

For six weeks, Margaret remained on artificial ventilation while her family agonized over every medical decision. Her daughter begged doctors to respect what Margaret had said, but without a legal document, the medical team had to continue treatment. The family watched helplessly as Margaret lingered in a state she'd explicitly said she never wanted.

Only 1% of UK adults have completed an advance care plan, and just 28% are even aware that advance decisions exist. The confusion is understandable—many people think a "living will" is the same as a regular will. It's not.

This article explains what a living will (advance decision) actually is, how it differs from a last will and testament, and why you need both documents for comprehensive end-of-life planning.

Table of Contents

A living will is legally known as an Advance Decision to Refuse Treatment (ADRT) in the UK. It's a legally binding document where you specify which medical treatments you want to refuse in the future if you become unable to communicate your wishes.

Sections 24-26 of the Mental Capacity Act 2005 govern advance decisions in England and Wales. The legal framework requires three core elements: you must be 18 or older, you must have mental capacity when making it, and you must specify which treatments you're refusing.

The legal status varies by UK jurisdiction. Advance decisions are legally binding in England, Wales, and Northern Ireland under the Mental Capacity Act 2005. In Scotland, living wills aren't legally binding, but doctors should consider them when making treatment decisions.

You might hear different terms for the same document: living will, advance directive, advance decision, or ADRT. They all refer to the same legal instrument governed by the Mental Capacity Act.

What a living will does is straightforward—it lets you refuse specific medical treatments you don't want in the future if you lose capacity to communicate. James, 52, created an advance decision refusing CPR and artificial ventilation if he develops advanced dementia with no realistic chance of recovery. His document gives him control over his medical care even if he can't speak for himself.

Emma, 71, specified in her advance decision that she doesn't want a feeding tube if she has a massive stroke with no prospect of regaining consciousness. Her specific refusals are legally binding once she loses capacity to make the decision herself.

What a living will cannot do is equally important. You can't request illegal treatments, can't demand specific treatments (you can only refuse), and can't request assisted dying, which remains illegal in the UK.

The statistics reveal a significant knowledge gap. 28% of UK adults aged 55+ are aware of advance care plans, with only 1% having completed one. Even more telling, 54% of people surveyed have not thought about their end-of-life wishes, and only 17% have informed someone.

Living Will vs. Last Will and Testament: What's the Difference?

A living will and a last will are two completely different legal documents, each serving a distinct purpose. The confusion is understandable—both use the word "will," and both involve advance planning. But they operate at different times and cover entirely different decisions.

Here's the critical distinction:

Aspect Living Will (Advance Decision) Last Will and Testament
Purpose Medical treatment refusal Asset distribution
When It Takes Effect While alive but incapacitated After death
What It Covers Healthcare decisions only Property, guardians, executors
Legal Framework Mental Capacity Act 2005 Wills Act 1837
Who Makes Decisions You (made in advance) Executor carries out your wishes

Your living will protects your medical autonomy while you're alive. Your last will protects your family and assets after you die. Both are essential, but they serve completely different purposes.

You cannot include advance decisions in your last will and testament. They must be separate documents. Your last will takes effect after death—far too late to guide medical treatment while you're alive. Putting advance decisions in your will could make them invalid or inaccessible when doctors need them.

Think of it as a timeline: your living will is active during periods of incapacity, then at death your last will becomes active to distribute your estate.

Robert, 64, illustrates this perfectly. He wrote his last will with WUHLD, distributing his £450,000 estate to his wife and children. Separately, he created an advance decision refusing kidney dialysis if he develops end-stage renal failure with dementia.

The two documents work together seamlessly. The living will ensures doctors respect his treatment wishes while he's alive. His last will ensures his estate goes to his chosen beneficiaries after death. Neither document can do the other's job.

How Does a Living Will Work Under UK Law?

An advance decision becomes active when you lack mental capacity to make or communicate the specific treatment decision yourself. Healthcare professionals must follow valid and applicable advance decisions—it's a legal requirement under the Mental Capacity Act 2005.

Section 24(1) of the Mental Capacity Act 2005 states that an advance decision must specify the treatment being refused and can specify particular circumstances. You can use lay terms—saying "tummy" instead of "stomach" is perfectly acceptable as long as your meaning is clear.

For an advance decision to be followed, it must be both valid and applicable.

What "valid" means: you haven't withdrawn it, you haven't created an LPA that contradicts it, and you haven't done anything clearly inconsistent with it since making it.

What "applicable" means: the circumstances match what you specified, there are no reasonable grounds to believe circumstances changed in ways you didn't anticipate, and you currently lack capacity to make the decision.

Doctors have specific obligations before following or overriding an advance decision. They must check its validity and applicability. If both conditions are met, they're legally protected from liability when they follow your advance decision.

The law explicitly protects this. As Section 25(3) states: "An advance decision is not applicable to the treatment in question if at the material time the person has capacity to give or refuse consent to it."

Sarah's situation demonstrates how this works in practice. She created an advance decision in 2019 refusing chemotherapy if she developed terminal cancer with less than six months to live. In 2024, she's diagnosed with terminal pancreatic cancer.

Doctors confirm she has capacity now, so her advance decision doesn't apply yet. She can make her own treatment decisions while she has capacity. If her capacity deteriorates, the advance decision becomes applicable, and doctors must follow it.

Living Will vs. Lasting Power of Attorney: Which Do You Need?

A Lasting Power of Attorney for Health and Welfare appoints someone (your attorney) to make healthcare decisions on your behalf. A living will means you make your own decisions in advance about specific treatments to refuse.

The key difference comes down to flexibility versus certainty. An LPA gives your attorney flexibility to adapt to circumstances. A living will gives certainty—your specific refusals are binding regardless of circumstances.

If you have both documents, the question of which takes priority matters. Under Section 11(7)(a) of the Mental Capacity Act 2005, your attorney can't override an advance decision that meets the legal requirements for refusing life-sustaining treatment.

Here's the practical comparison:

Aspect Living Will (Advance Decision) LPA for Health and Welfare
Decision-maker You (in advance) Your chosen attorney
Flexibility Fixed (can't adapt to new circumstances) Flexible (attorney adapts)
Scope Only refusal of specific treatments All healthcare decisions
Legal status Binding if valid and applicable Attorney must follow MCA principles
Cost Free to create £92 registration fee

Best practice is to have both documents. Use your LPA for general decisions and your advance decision for specific treatments you definitely want to refuse.

David, 58, created both documents. His advance decision refuses CPR if he has severe dementia with no quality of life. His LPA for Health and Welfare appoints his wife to make other medical decisions—where to receive care, which hospital, experimental treatments.

This combination gives him control over specific refusals while giving his wife flexibility for everything else. She knows his firm boundaries (no CPR with advanced dementia), but she can adapt other decisions to circumstances he couldn't have predicted.

What Can and Can't You Include in a Living Will?

The law draws clear boundaries around what advance decisions can cover. Understanding these limits is essential for creating a valid document.

You can refuse any of these:

  • Life-sustaining treatments: CPR, artificial ventilation, artificial nutrition and hydration (if properly documented)
  • Medical interventions: chemotherapy, dialysis, surgery, blood transfusions, antibiotics
  • Diagnostic tests: if they would lead to treatments you don't want
  • Any treatment, even if refusal may result in death

You cannot request:

  • Assisted dying or euthanasia (illegal in UK under current law)
  • Specific treatments (advance decisions only refuse, never demand)
  • Basic care: pain relief, keeping comfortable, oral food and drink if you can swallow
  • Actions that would cause your death through intentional killing

Section 62 of the Mental Capacity Act 2005 makes this explicit: the Act does not change laws on murder, manslaughter, or assisting suicide.

Refusing life-sustaining treatment requires special formalities under Sections 25(5) and (6) of the Mental Capacity Act 2005:

  • Must be in writing
  • Must be signed by you
  • Must be witnessed by someone independent (not a beneficiary of your will)
  • Must include this statement: "This advance decision applies even if my life is at risk"

Without these formalities, refusals of life-sustaining treatment aren't legally binding.

Michael, 62, wants to refuse dialysis if he develops kidney failure alongside advanced dementia. This is a valid advance decision. He cannot, however, request that doctors actively end his life if he's suffering—that would be assisted dying, which is illegal in the UK.

An advance decision lets you refuse treatments but cannot request illegal actions or demand specific treatments. The power is in refusal, not in making demands.

How to Make a Living Will in the UK (Step-by-Step)

Creating a legally valid advance decision doesn't require a solicitor for straightforward situations. Follow these steps to create yours:

Step 1: Determine What Treatments You Want to Refuse

Be specific about which treatments you're refusing and under what circumstances.

Instead of vague statements like "I refuse life support," specify: "I refuse CPR if I have advanced dementia with no realistic prospect of recovery." You can use lay terms as long as your meaning is clear—"tummy" instead of "stomach" is acceptable.

Consider these conditions: terminal illness, permanent unconsciousness, advanced dementia, specific diseases you want to refuse treatment for.

Step 2: Choose Your Format

Use templates from reputable organizations. Compassion in Dying offers a free online service that guides you through creating your advance decision. Age UK provides comprehensive factsheets and templates.

If you're refusing life-sustaining treatment, your advance decision must be written, signed, and witnessed. If you're refusing only non-life-sustaining treatments, verbal refusals are technically valid, but written is strongly recommended for clarity.

Step 3: Complete the Document

Include these essential elements:

  • Your full name, address, and date of birth
  • Specific treatments you're refusing
  • Specific circumstances when refusals apply
  • If refusing life-sustaining treatment: the statement "This advance decision applies even if my life is at risk"
  • Your signature and date
  • Witness signature (someone 18 or older, not a beneficiary of your will)

Step 4: Share and Store

Give copies to everyone who might need them:

  • Your GP (ask them to add it to your medical records)
  • Hospital if you're currently a patient
  • Family members who might be contacted in medical emergencies
  • Your LPA attorney if you have one

Keep the original in a safe place where family can find it. Consider carrying a card in your wallet indicating you have an advance decision and where it's stored.

Step 5: Review Regularly

Review your advance decision every three to five years or after major life changes. Medical treatments evolve, and your wishes might change.

If you update it, destroy old copies completely and redistribute the new version. Tell everyone who had the old version that you've updated it.

Free resources make this process straightforward. Compassion in Dying's online service has helped 34,000 people create advance decisions since 2016. Their step-by-step guidance ensures you meet all legal requirements.

When Should You Make a Living Will?

Creating an advance decision becomes important at specific life stages and circumstances. You must have mental capacity when you create it—once capacity is lost, it's too late.

Ideal timing includes:

When you're diagnosed with serious illness like cancer, heart disease, kidney disease, or dementia. These diagnoses make end-of-life scenarios more tangible.

At age 60 or older when end-of-life planning becomes more concrete. You're still healthy enough to think clearly about your wishes without the pressure of immediate crisis.

After experiencing family conflict over someone else's medical care. Watching family members struggle with decisions often motivates people to spare their own families the same burden.

When creating other estate planning documents. If you're making your will, it's the perfect time to think about advance decisions.

Before major surgery if you have strong treatment preferences. Even planned procedures carry risks, and having your wishes documented provides clarity.

If you have conditions that may affect capacity, like early dementia or high stroke risk. Create your advance decision while you definitely have capacity.

Why sooner is better: Capacity can vanish suddenly through stroke, accident, or sudden illness. 54% of UK adults have not thought about their end-of-life wishes, and only 7% have put wishes in writing.

Helen, 66, created her advance decision after watching her mother suffer through aggressive cancer treatment she didn't want. Helen wants to ensure her children don't face the same uncertainty she experienced.

Tom, 58, was diagnosed with early-stage Parkinson's disease. He created both a will with WUHLD and an advance decision while he still has full capacity to make decisions. He doesn't know when his capacity might deteriorate, so he's documenting his wishes now.

Creating a living will isn't about giving up—it's about maintaining control. It's your voice when you can't speak, ensuring your medical care reflects your values even if you can't communicate them.

How Living Wills and Last Wills Work Together

Comprehensive end-of-life planning requires multiple documents working together. Your living will and last will are two pieces of a complete framework.

The complete planning framework includes:

  1. Living will (advance decision): Medical treatment decisions while you're alive but incapacitated
  2. Last will and testament: Property distribution, guardian appointments, executor designation after death
  3. LPA for Health and Welfare: Appoints someone for general healthcare decisions
  4. LPA for Property and Financial Affairs: Appoints someone to manage money and property
  5. Funeral wishes: Can be in your will or separate document

Your last will has no authority over medical decisions while you're alive. Your living will has no authority over your estate after death. Together they create seamless planning from incapacity through death to estate distribution.

Integration points matter. Your executor (named in your last will) should know about your advance decision. Your LPA attorneys should have copies of both your living will and last will. Store both documents together and share with the same people.

Here's how the timeline works when serious illness leads to death:

Phase 1 (Incapacitated but alive): Living will guides doctors on treatment refusals. LPA for Health makes other decisions your advance decision doesn't cover.

Phase 2 (Death occurs): Last will takes effect. Executor distributes estate according to your wishes.

Result: Seamless transition with your wishes respected throughout.

Patricia, 69, demonstrates comprehensive planning. Her advance decision refuses life-sustaining treatment if she has severe stroke with no recovery prospect. Her last will (created with WUHLD) leaves her £320,000 estate to her children and appoints her daughter as executor.

When Patricia has a massive stroke at 74, doctors respect her advance decision and don't put her on artificial ventilation. After she passes peacefully, her daughter (as executor) distributes the estate according to Patricia's will.

Both documents worked together exactly as intended. Patricia maintained her medical autonomy during incapacity, and her estate was distributed precisely as she wanted after death.

Common Living Will Myths and Mistakes

Misconceptions about advance decisions prevent many people from creating them. Let's address the most common myths.

Myth 1: "A living will means doctors will give up on me"

Reality: Doctors still provide all appropriate care. Your advance decision only prevents treatments you specifically refused. You still get pain relief, comfort care, and any treatments you didn't refuse.

Myth 2: "If I have a living will, I can't change my mind"

Reality: You can revoke or change your advance decision at any time while you have capacity. Simply tell someone verbally, destroy the document, or create a new one. The power to change your mind never disappears while you have capacity.

Myth 3: "My family can override my living will"

Reality: A valid advance decision is legally binding. Family cannot override it, and doctors must follow it if it's applicable to the situation. Your family's preferences, no matter how strongly held, don't supersede your documented wishes.

Myth 4: "I can include my living will in my last will and testament"

Reality: No. Advance decisions must be separate documents. Your last will takes effect after death—advance decisions apply while you're alive. Putting advance decisions in your will could make them invalid or inaccessible when needed.

Myth 5: "Living wills are only for elderly or terminally ill people"

Reality: Capacity can be lost at any age due to accidents, strokes, or sudden illness. If you're 18 or older and have treatment preferences, you can create an advance decision. Young adults in high-risk occupations or with specific values often create them.

Common mistakes to avoid:

Being too vague. "I don't want heroic measures" means nothing legally. Specify which treatments you refuse under which circumstances.

Not witnessing life-sustaining treatment refusals. Without a witness, refusals of life-sustaining treatment aren't valid.

Not sharing with GP or family. They can't follow your wishes if they don't know the advance decision exists. Share it widely.

Creating one then forgetting about it. Review every three to five years or after major life changes.

Using old or American terminology. Use "advance decision" (UK legal term), not "advance directive" (American term).

Without an advance decision, doctors must treat you according to "best interests" under the Mental Capacity Act 2005. They'll consult your family, but your family's view isn't legally binding. This often leads to treatments you wouldn't want and family conflict over what you would have chosen.

Frequently Asked Questions

Q: What is a living will in the UK?

A: A living will, legally known as an Advance Decision to Refuse Treatment (ADRT), is a legally binding document where you specify which medical treatments you want to refuse in the future if you become unable to communicate your wishes. It's governed by the Mental Capacity Act 2005 and applies in England and Wales.

Q: What's the difference between a living will and a last will?

A: A living will covers medical treatment decisions while you're alive but unable to communicate. A last will and testament distributes your property after death. The living will takes effect during incapacity; your last will takes effect after you die. You need both documents for complete planning.

Q: Is a living will legally binding in the UK?

A: Yes, a living will (advance decision) is legally binding in England, Wales, and Northern Ireland under the Mental Capacity Act 2005. Healthcare professionals must follow it if it's valid and applicable. In Scotland, living wills aren't legally binding but doctors should consider them when making treatment decisions.

Q: Do I need a solicitor to make a living will?

A: No, you don't need a solicitor to make a living will in the UK. You can create one yourself using free templates from organizations like Compassion in Dying or Age UK. However, if refusing life-sustaining treatment, it must be in writing, signed by you, and witnessed by someone independent.

Q: What's the difference between a living will and a Lasting Power of Attorney?

A: A living will is your own decision about specific treatments you want to refuse. A Lasting Power of Attorney (LPA) for Health and Welfare appoints someone to make healthcare decisions on your behalf. An LPA gives flexibility; a living will gives specific instructions. Many people have both.

Q: Can I change or cancel my living will?

A: Yes, you can change or cancel (revoke) your living will at any time while you have mental capacity. You can do this verbally, in writing, or by destroying the document. If you make changes, inform your doctor, family, and anyone who has a copy of the original.

Q: Does a living will work with my regular will?

A: Yes, a living will and a last will work together as part of comprehensive end-of-life planning. Your living will covers medical decisions while you're alive but incapacitated. Your last will covers asset distribution after death. Both documents should be part of your estate planning.

Conclusion

Comprehensive end-of-life planning requires understanding and creating multiple documents:

  • A living will (advance decision) covers medical treatment refusal while you're alive but incapacitated; a last will covers estate distribution after death—you need both for complete planning
  • Living wills are legally binding in England, Wales, and Northern Ireland under the Mental Capacity Act 2005, and must be followed by healthcare professionals if valid and applicable
  • If refusing life-sustaining treatment, your advance decision must be written, signed by you, witnessed, and include the statement "This advance decision applies even if my life is at risk"
  • Living wills and Lasting Powers of Attorney work together: advance decisions give specific treatment refusals, LPAs give someone flexibility to make other decisions on your behalf
  • Create your advance decision using free templates from Compassion in Dying or Age UK, then share with your GP, family, and anyone who has your LPA

Comprehensive end-of-life planning means having both documents in place: a living will to protect your medical autonomy while you're alive, and a last will to protect your family and assets after you die. Neither replaces the other—they work together to ensure your wishes are respected at every stage.

Taking control of both decisions now gives you peace of mind and reduces burden on the people you love.

Need Help with Your Will?

While a living will addresses medical decisions during incapacity, your last will and testament ensures your estate is distributed according to your wishes after death. Both documents are essential for complete end-of-life planning, and creating your will is the straightforward first step you can complete today.

Create your will with confidence using WUHLD's guided platform. For just £99.99, you'll get your complete will (legally binding when properly executed and witnessed) plus three expert guides. Preview your will free before paying anything—no credit card required.

Legal Disclaimer: This article provides general information only and does not constitute legal or financial advice. WUHLD is not a law firm and does not provide legal advice. Laws and guidance change and their application depends on your circumstances. For advice about your situation, consult a qualified solicitor or regulated professional. Unless stated otherwise, information relates to England and Wales.

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