(Updated 21/07/2023)
What is an advance decision?
An advance decision (sometimes known as an advance decision to refuse treatment, an ADRT, or a living will) is a decision you can make now to refuse a specific type of treatment at some time in the future.
It lets your family, carers and health professionals know your wishes about refusing treatment if you’re unable to make or communicate those decisions yourself.
The treatments you’re deciding to refuse must all be named in the advance decision.
You may want to refuse a treatment in some situations, but not others. If this is the case, you need to be clear about all the circumstances in which you want to refuse this treatment.
Deciding to refuse a treatment is not the same as asking someone to end your life or help you end your life.
Who makes an advance decision?You make the advance decision, as long as you have the mental capacity to make such decisions.
You may want to make an advance decision with the support of a clinician.
If you decide to refuse life-sustaining treatment in the future, your advance decision needs to be:
- written down
- signed by you
- signed by a witness
If you wish to refuse life-sustaining treatments in circumstances where you might die as a result, you need to state this clearly in your advance decision. Life-sustaining treatment is sometimes called life-saving treatment.
You may find it helpful to talk to a doctor or nurse about the kinds of treatments you might be offered in the future, and what it might mean if you choose not to have them.
The charity Compassion in Dying has an advance decision form you can fill in online or by hand, with suggestions for things to think about.
Is an advance decision legally binding?
An advance decision is legally binding as long as it:
- complies with the Mental Capacity Act
- is valid
- applies to the situation
If your advance decision is binding, it takes precedence over decisions made in your best interest by other people.
An advance decision may only be considered valid if:
- you’re aged 18 or over and had the capacity to make, understand and communicate – your decision when you made it
- you specify clearly which treatments you wish to refuse
- you explain the circumstances in which you wish to refuse them
- it’s signed by you (and by a witness if you want to refuse life-sustaining treatment)
- you have made the advance decision of your own accord, without any harassment by anyone else
- you have not said or done anything that would contradict the advance decision since you made it (for example, saying that you’ve changed your mind)
How does an advance decision help?
As long as it’s valid and applies to your situation, an advance decision gives your health and social care team clinical and legal instructions about your treatment choices.
An advance decision will only be used if, at some time in the future, you’re not able to make your own decisions about your treatment.
Does an advance decision need to be signed and witnessed?
Yes, if you’re choosing to refuse life-sustaining treatment.
In this case, the advance decision must be written down, and both you and a witness must sign it.
You must also include a statement that the advance decision applies even if your life is at risk.
Who should see it?
You have the final say on who sees it, but you should make sure that your family, carers or health and social care professionals know about it, and know where to find it.
Your family or carers may have to find it quickly if you require emergency treatment and they need to tell the healthcare professionals your wishes.
You can keep a copy in your medical records.
More information
- Age UK: advance statements and living wills
- Alzheimer’s Society: making an advance decision
- Compassion in Dying: making decisions and planning your care
- Dying Matters: legal and ethical issues around advance care planning, including advance decisions
- Dying Matters: planning ahead for your future care (PDF, 393kb)
- healthtalk.org: videos and written interviews of people talking about making an advance decision
- Macmillan: information on making an advance decision
Other Useful Information:
Advance decisions, advance statements and living wills – factsheet from Age UK.
