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Advance Decision / Living Will

Also known as: Advance Directive, ADRT, Living Will

Definition

An advance decision (also called a living will) is a legally binding document where you specify medical treatments you want to refuse if you later become unable to make or communicate decisions yourself.

What Does Advance Decision / Living Will Mean?

An advance decision, formally known as an Advance Decision to Refuse Treatment (ADRT), is a legal document created under the Mental Capacity Act 2005 that allows you to refuse specific medical treatments in advance. Also called a living will, it only becomes active if you lose mental capacity—the ability to understand, retain, and weigh information to make decisions. Unlike a Health and Welfare LPA, an advance decision doesn't appoint anyone; it documents your own treatment refusals. For an advance decision to be legally binding, it must be both valid (properly made and not withdrawn) and applicable (covering the specific treatment in circumstances).

Requirements depend on what you're refusing. For routine treatments, your decision can be verbal or written. However, for life-sustaining treatment—CPR, ventilation, tube feeding, or blood transfusions—strict requirements apply: it must be in writing, signed by you and a witness, and include the statement "even if my life is at risk." Sarah, 68, creates an advance decision refusing tube feeding and CPR if she develops dementia and no longer recognizes her family. She writes it, signs it, has her daughter witness it, and keeps copies with her GP. Healthcare professionals must follow valid and applicable advance decisions.

You can change or cancel your advance decision at any time while you have capacity. If you later create a Health and Welfare LPA, whichever document is most recent takes priority. An advance decision isn't the same as euthanasia or assisted suicide (which remain illegal in the UK)—it's about refusing treatment, not requesting help to end your life. Unlike LPAs, advance decisions don't need registration with the Office of the Public Guardian, making them simpler and free to create.

Common Questions

"What's the difference between an advance decision and a Health and Welfare LPA?"

An advance decision lets you refuse specific treatments but doesn't appoint anyone to act for you. A Health and Welfare LPA appoints an attorney to make all healthcare decisions on your behalf if you lack capacity. Many people have both—the LPA for flexibility and the advance decision for specific refusals.

"Does an advance decision need to be registered like an LPA?"

No, advance decisions don't need registration with the Office of the Public Guardian. However, for life-sustaining treatment refusals, your advance decision must be in writing, signed by you and a witness, with the statement that it applies even if your life is at risk. Keep copies with your GP and family.

"Can I change or cancel my advance decision once I've made it?"

Yes, you can change or cancel your advance decision at any time while you have capacity. You can do this verbally or in writing, though written is clearer. If you make a Health and Welfare LPA after an advance decision, whichever is most recent takes priority.

Common Misconceptions

Myth: "An advance decision is the same as euthanasia or asking doctors to end your life"

Reality: An advance decision allows you to refuse treatments—it's about declining intervention, not requesting help to die. Euthanasia and assisted suicide remain illegal in England and Wales. Your advance decision might refuse life-sustaining treatment like CPR or ventilation, but this differs from asking someone to actively end your life. Healthcare professionals won't start refused treatments but still provide comfort care.

Myth: "You need a solicitor to make a valid advance decision, and it costs hundreds of pounds"

Reality: You don't legally need a solicitor to create an advance decision, and there's no registration fee. You can write your own for free as long as it's clear about which treatments you're refusing and when. For life-sustaining treatment refusals, write it down, sign it, have a witness sign, and include the statement that it applies even if your life is at risk.

  • Health and Welfare LPA: Appoints someone to make healthcare decisions for you, unlike an advance decision which only refuses specific treatments.
  • Mental Capacity: You need capacity to make an advance decision, but it only applies when you later lack capacity.
  • End of Life: Common situation where advance decisions refuse life-sustaining treatment, though they apply to any capacity loss.
  • Attorney: Your attorney must follow your advance decision if it's valid and applicable to your situation.

Need Help with Your Will?

Planning ahead for medical preferences is important—and so is having a valid will to protect your estate. While you consider an advance decision, ensure your estate is properly planned too.

Create your will with confidence using WUHLD's guided platform. For just £99.99, you'll get your complete, legally binding will 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.