Advance Decision (Living Will) Explained: A UK Guide

Picture a woman in her early eighties who has watched her husband spend his last two years on a hospital ward, kept alive through repeated infections and tube feeding, long after he stopped recognising her. She knows exactly what she would want if the same thing happened to her. She has told her daughter, her GP and her best friend. She has said it out loud more than once at the kitchen table.

Then she has a major stroke. She cannot speak. The medical team, meeting her for the first time, has to decide whether to start treatment that might keep her alive for months or years. Her daughter repeats what her mother said. The doctors listen carefully and take it into account. But a remembered conversation is not the same as a clear, signed document, and the final decision is theirs.

That document has a name: an advance decision to refuse treatment, often called a living will. It is one of the least understood pieces of end-of-life planning in the UK, and one of the most powerful.

Around 1,800 people die in the UK every day, part of the roughly 170,000 deaths a day you can watch on our live counter. A large share of those deaths come after a period when the person could not make or communicate decisions about their own care. This guide explains what an advance decision is, how to make one that doctors must follow in England and Wales, how it fits with a lasting power of attorney, and how things work in Scotland and Northern Ireland.

What an advance decision is

An advance decision lets you refuse specific medical treatments in advance, in case a time comes when you cannot make or communicate that decision yourself. In England and Wales it is set out in the Mental Capacity Act 2005.

If it is valid and applies to the situation, it is legally binding. Doctors must follow it, in the same way they would have to follow your refusal if you could speak for yourself.

Term	Meaning
Advance decision (ADRT)	A refusal of specific treatment, made in advance, that is legally binding if valid and applicable
Living will	Common, informal name for an advance decision
Advance statement	A record of your wishes, values and preferences. Taken into account but not legally binding
Life-sustaining treatment	Treatment that could keep you alive, such as ventilation, CPR or artificial nutrition
Mental capacity	Being able to understand, remember and weigh up information to make a decision
DNACPR	A clinical decision not to attempt CPR, recorded by a doctor

Two limits matter. An advance decision can only refuse treatment. It cannot demand a particular treatment, and it cannot ask for anything illegal, such as help to end your life. It also cannot refuse basic care, such as being kept warm and clean, or being offered food and drink by mouth.

Who can make one

You can make an advance decision if you are 18 or over and have the mental capacity to make it. You do not need a solicitor, and there is no official form or fee. Many people use free templates from charities such as Compassion in Dying, or ask their GP or hospice team for help.

Requirement	Detail
Age	18 or over
Capacity	You must have capacity when you make it
Specific treatments	You must say which treatments you are refusing
Circumstances	You should say when the refusal applies
Freely made	Nobody can pressure you into it
Cost	No official fee. A solicitor will charge if you use one

Making it legally binding

The rules depend on what you are refusing. The key distinction is whether the treatment is life-sustaining.

	Refusing other treatment	Refusing life-sustaining treatment
Must be in writing	Recommended, not required	Yes
Must be signed by you	Recommended	Yes (or by someone else in your presence, at your direction)
Must be witnessed	Recommended	Yes, the witness must sign too
Must state it applies even if your life is at risk	Not needed	Yes, explicitly

The NHS is clear that if you want to refuse treatment that could keep you alive, you must say so in plain words. Many forms include a sentence such as: "I am refusing this treatment even if my life is at risk as a result." Without that statement, a refusal of life-sustaining treatment is not binding.

It also helps to be precise. "No heroic measures" means different things to different people. "I refuse CPR if I have advanced dementia and no longer recognise my family" leaves far less room for doubt.

When an advance decision does not apply

Even a well-written advance decision can be set aside in some situations.

Situation	Effect
You still have capacity	Doctors ask you directly. The document is not used
You withdrew it or acted in a way clearly inconsistent with it	It may not be valid
You later made a health and welfare LPA covering the same treatment	The attorney decides instead
The treatment or circumstances are not the ones described	It does not apply
There are reasonable grounds to think you would not have made it now, for example new treatments	It may not apply

This is why reviewing it regularly matters. A short note saying "reviewed and still my wishes" with a date and signature every year or two makes it much harder to argue that your views have changed.

Advance decision vs LPA vs DNACPR

People often confuse these three, and many families end up with one when they meant another.

	Advance decision	Health and welfare LPA	DNACPR form
Who makes it	You	You	A doctor, ideally after talking with you
What it does	Refuses specific treatment	Appoints people to decide for you	Records that CPR should not be attempted
Legally binding	Yes, if valid and applicable	Attorney's decisions carry legal weight	It is a clinical decision, not a legal instruction from you
Covers	Only the treatments you list	Most health and care decisions, if you give that power	CPR only
Registration	None needed	Must be registered with the Office of the Public Guardian	Kept on your medical record

An advance decision is precise but narrow. An LPA is broad and flexible, because your attorney can respond to situations you never imagined. Many people make both. If you do, make sure they agree, and remember that a health and welfare LPA made after your advance decision, giving your attorney power over the same treatment, takes priority.

A DNACPR is different again. It is a decision made by a doctor about whether CPR is likely to work and be in your interests. You can ask for a conversation about it, and an advance decision refusing CPR will be taken into account, but you cannot insist on CPR if a doctor thinks it would not work. In many areas a ReSPECT form is now used to record CPR decisions alongside wider treatment preferences.

What to include

A typical advance decision covers these points.

Section	What to write
Your details	Full name, date of birth, address, NHS number if you have it
GP details	Name and surgery
Treatments refused	For example CPR, mechanical ventilation, artificial nutrition and hydration, antibiotics for life-threatening infection
Circumstances	For example "if I have advanced dementia", "if I am permanently unconscious"
Life at risk statement	Needed for any life-sustaining treatment
Signature, date, witness	Required for life-sustaining refusals
Review dates	Optional but strongly recommended

You can also write an advance statement at the same time. It is not binding, but it tells people what matters to you: where you would like to be cared for, whether you want music on, religious needs, who you want to visit. Our guide to what happens in the last days of life covers the kinds of comfort choices people often want to record, and where most people die explains why so many people end up in hospital when they had hoped to die at home.

Making sure it is found

An advance decision only works if the people treating you know it exists. There is no national register in England and Wales, so the burden falls on you.

Who should know	What to do
Your GP	Ask for a copy to be added to your records
Hospital or hospice team	Give a copy if you are already being treated
Family and close friends	Tell them it exists and where it is kept
Your attorney, if you have an LPA	Give them a copy so they know your wishes
You	Carry a card in your wallet saying you have one and where to find it

Keep the original somewhere easy to find, not locked in a safe deposit box. The same is true of your will, your LPA and your passwords. Our When I'm Gone planner is designed to bring all of these together in one place, so your family is not hunting through drawers at the worst possible moment.

Scotland and Northern Ireland

The rules differ across the UK.

Nation	Legal position
England and Wales	Mental Capacity Act 2005. A valid, applicable advance decision is legally binding
Scotland	No specific statute. Advance directives must be taken into account under the Adults with Incapacity (Scotland) Act 2000 principles and carry considerable weight, but are generally seen as persuasive rather than strictly binding
Northern Ireland	Mainly common law. A clear, specific advance decision is widely regarded as legally effective. The Mental Capacity Act (Northern Ireland) 2016 is only partly in force

In Scotland, a welfare power of attorney plays a similar role to a health and welfare LPA, and doctors must consult your attorney. If you live in Scotland or Northern Ireland, it is worth getting local advice, and making your wishes as clear and specific as possible either way.

Why so few people make one

Surveys by end-of-life charities have repeatedly found that only a small minority of UK adults have written down their wishes about treatment, even though most say they have views. The reasons are familiar: it feels morbid, it seems complicated, or it feels like something for later.

Yet the situations an advance decision covers are not rare. Dementia is now the leading cause of death in England and Wales, and dementia deaths have roughly doubled in 20 years. Many people in the 85 and over age group spend their final months without the capacity to decide about treatment. One of the top regrets of the dying is not having lived life on your own terms. An advance decision is a way of keeping some of that control at the very end.

Common questions

Do I need a solicitor? No. You can write one yourself. A solicitor or a charity helpline can help if your situation is complex.

Can my family overrule it? No. If it is valid and applies, doctors must follow it, even if your family disagree. That is why talking to them in advance matters.

Can I change my mind? Yes, at any time while you have capacity. Withdraw it in writing if you can, and tell your GP.

Does it cover assisted dying? No. An advance decision can only refuse treatment. It cannot ask for help to end your life.

Is it the same as a will? No. A will deals with your money and property after you die. An advance decision deals with medical treatment while you are still alive.

The bottom line

An advance decision lets you say no, in advance, to treatments you would not want. Made properly, it is legally binding in England and Wales. For life-sustaining treatment it must be written, signed, witnessed and must say clearly that it applies even if your life is at risk. Pair it with a health and welfare LPA, tell your GP and your family, and review it every few years.

If you are working through the paperwork, our guides to writing a will, lasting power of attorney and planning your own funeral cover the rest, and what your family needs to know when you're gone shows how to pull it all together.

While you were reading this, about 15 people died in the UK and more than 1,400 around the world, a number you can watch rising on our live death counter. Writing down what you want takes an evening. It can spare the people you love from guessing.

Sources: NHS, Advance decision to refuse treatment (living will) and Advance statement about your wishes; Mental Capacity Act 2005, sections 24 to 26, and Code of Practice; GOV.UK, Make, register or end a lasting power of attorney; Resuscitation Council UK, ReSPECT process; Compassion in Dying, advance decision guidance; Adults with Incapacity (Scotland) Act 2000 and guidance from the Office of the Public Guardian (Scotland); Northern Ireland Assembly research briefings on mental capacity; Mental Capacity Act (Northern Ireland) 2016; ONS, leading causes of death in England and Wales. Rules can change, so check the NHS and GOV.UK for current guidance. This article is general information, not legal or medical advice. For complex situations, speak to a solicitor, your GP or your care team.