England & Wales ONLY • Plain English • Scotland has no equivalent statutory regime
This is general legal information, not legal advice.

Advance Decision (“Living Will”) — Guide (England & Wales)

What it is • valid and applicable • life-sustaining treatment formalities • advance statement compared • health & welfare LPA compared • how to word it
Quick summary: an advance decision — also called a living will or an ADRT — is a decision you make now to refuse specific treatments in the future, if you can no longer communicate your wishes. In England and Wales it is legally binding, but only where it is both valid and applies to the actual situation.
This page explains what an advance decision can and cannot do, the four extra requirements that apply when you are refusing life-sustaining treatment, how it differs from an advance statement (which is not binding) and from a health and welfare LPA (which appoints a person instead), and the wording mistakes that stop one working.
Specialty: England & Wales advance-decision guidance focused on the two failure modes that matter — writing wishes instead of refusals, and refusing life-sustaining treatment without the four formalities that make that refusal bind.
If you have a diagnosis, you are planning ahead after seeing someone else’s end of life, or you have written something already and want to know whether it would actually be followed, start here.
What AI Lawyer can do on this topic (free plan)
  • Draft an advance decision to refuse treatment — structured so each refusal names a treatment and the circumstances it applies in.
  • Life-sustaining treatment check — make sure the four requirements are present if you are refusing that.
  • Separate out your advance statement material — the preferences and values that belong in a different document.
A draft is a starting point. This is general legal information, not legal advice — and this is a decision worth discussing with your doctor.
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Valid & applicable
Wording checks
Life-sustaining treatment
LPA comparison
Best for people saying:
  • “I want to write a living will.”
  • “Would what I’ve written actually be followed?”
  • “Do I need an advance decision or an LPA — or both?”
  • “What’s the difference between a decision and a statement?”
  • “I’ve had a diagnosis and want this in place.”
  • “Does it need to be witnessed?”
You can start with one paragraph. We’ll ask only what’s needed.

How this guide helps

Three steps — clear, practical, risk-aware.
1) Work out which document you need
A refusal of a named treatment, a statement of preferences and values, or an appointed decision-maker. They do different jobs and only one of them binds.
Example: “I want to refuse a specific treatment, not appoint anyone.”
2) Name the treatment and the circumstances
An advance decision binds only where it is valid and applies to the situation in front of the clinician. Vague drafting is what makes it not apply.
Specific beats sweeping, every time.
3) Get the formalities right if life is at risk
Refusing life-sustaining treatment carries four extra requirements. Miss any one and the refusal does not bind in exactly the situation it was written for.
This is the most common fatal defect.

What an advance decision is — and what it is not

Its whole function is refusal.
The NHS defines an advance decision — also called a living will or an ADRT — as a decision made now to refuse specific treatments in the future if you are unable to communicate your wishes. It is a refusal mechanism. That is what it does; it is not a wish list.
The NHS sets out the conditions an advance decision has to meet before it can be treated as valid. You must have been aged 18 or over and had the capacity to make, understand and communicate the decision when you made it. You must specify clearly which treatments you are refusing and explain the circumstances in which you are refusing them. It must be signed by you — and by a witness as well if you are refusing life-sustaining treatment. You must have made it of your own accord, without harassment by anyone else. And you must not have said or done anything since that would contradict it.
Why it exists is worth understanding, because it explains why it has teeth. The NHS puts the underlying principle plainly: where an adult has the capacity to make a voluntary and informed decision to consent to, or refuse, a particular treatment, that decision must be respected — and that is still the case even if refusing treatment would result in their death. An advance decision is the mechanism that carries that right forward into a time when you can no longer speak for yourself.

When it actually binds: valid and applicable

A two-part test. Fail either half and it does not bind.
An advance decision is legally binding — but only if it complies with the Mental Capacity Act, is valid, and applies to the situation. Where those conditions are met, it takes precedence over decisions made in your best interests. Anyone making a medical treatment decision for someone who lacks capacity must consider any living will that person has made.
The practical consequence is about drafting. A refusal written so broadly, or so vaguely, that a clinician standing at the bedside cannot tell whether it covers the actual circumstances is at risk of being treated as not applicable — and then it does nothing. Name the treatment. Name the circumstances. “No heroics” is not an advance decision.
The capacity rules underneath all of this
Capacity is assumed unless proved otherwise. It is decision-specific — a person can lack capacity for some decisions and still have capacity for others. A person cannot make a decision if they cannot understand the relevant information, retain it long enough, use or weigh it, or communicate their decision in any way. Where a person lacks capacity, the decision must be made in their best interests — and a valid, applicable advance decision takes precedence over that best-interests process.

Refusing life-sustaining treatment: four cumulative requirements

All four. Not three.
Where an advance decision refuses life-sustaining treatment, the NHS sets out four requirements. It must be:
  • Written down.
  • Signed by you.
  • Signed by a witness.
  • Stated to apply even if your life is at risk. That sentence has to actually be in the document.
This is the single most common fatal defect we see described. People write a careful, thoughtful refusal, sign it, have it witnessed — and leave out the “even if my life is at risk” wording. The refusal then does not bind for the exact situation it was written to cover.
Two of these — the witness signature and the “even if your life is at risk” wording — are attached specifically to life-sustaining treatment. Everything in the validity list further up this page still applies to every advance decision, whatever it refuses: your own signature, clearly naming the treatments, and explaining the circumstances they apply in. A refusal nobody can produce and read is a refusal that changes nothing.

No notary, no registration, no fee — and why that cuts both ways

Easier than an LPA to make. Easier to lose.
Nothing in the NHS process for an advance decision involves a notary, a registration body, a solicitor or a fee. That is a genuine advantage: a lasting power of attorney has to be registered with the Office of the Public Guardian before it can be used at all, and that takes weeks. An advance decision does not go through any of that.
The flip side is purely practical, and we flag it as practical rather than as a legal rule: because no register holds it, an advance decision only operates if the people treating you know it exists and can read it at the moment the decision is being made. Keep the original somewhere findable, give copies to the people closest to you, and talk to your GP or clinical team about it. We are not stating a legal notification requirement here — we did not verify one — but a document in a drawer nobody opens achieves nothing.

Advance statement, advance decision, lasting power of attorney

The NHS lists three planning-ahead tools. They are not alternatives so much as different jobs.
Advance statement — NOT binding
A written statement of your preferences, wishes, beliefs and values about future care: religious beliefs, where you want to be cared for, personal preferences. It is not legally binding, but anyone making decisions about your care must take it into account.
Advance decision — binding refusal
Legally binding where valid and applicable, and it works by refusing specific treatments. It does not appoint anybody and it does not describe preferences.
Health & welfare LPA — appoints a person
Appoints attorneys to decide for you. It can only be used once you are unable to make your own decisions, and it only reaches life-sustaining treatment if you chose Option A in section 5 of form LP1H. Option B leaves those decisions to doctors.
The mistake to avoid is writing wishes where you meant refusals. “I’d want to be at home”, “I don’t want to be a burden”, “use your judgement” are advance statement material — genuinely useful, and not binding. Both documents are worth having; only one of them binds.
Where a person has both a valid advance decision and a health and welfare LPA covering the same treatment, we do not state which prevails. That turns on statutory wording we could not verify from a primary source, and getting it wrong in either direction would be worse than saying nothing. If both exist in your family, take it to a solicitor. Health & welfare LPA guide →

What to have ready before you write one

You do not need everything — but these are the questions the document turns on.
The treatments you want to refuse
Named, one by one. Not a category, not a mood.
The circumstances each refusal applies in
This is the “applicable” half of the test doing its work.
Whether any refusal reaches life-sustaining treatment
If yes, the four requirements apply to that refusal.
Your diagnosis and clinical context
A conversation with your clinical team makes the wording sharper.
A witness
Required for a life-sustaining treatment refusal. We do not state who may or may not witness — that was not verified.
Your separate advance statement material
Preferences, beliefs and values, kept in their own document.

What on this page does NOT apply outside England & Wales

This is not a UK-wide page. It cannot be.
  • Scotland has no equivalent statutory regime. The Scottish Government’s own reform consultation records that Scots law lacks comprehensive statutory coverage of advance directives: only the Mental Health (Care and Treatment) (Scotland) Act 2003 provides a legal framework, and only for “advance statements” made by patients subject to compulsory orders — beyond that narrow scope, the common law prevails. The Adults with Incapacity (Scotland) Act 2000 contains no specific provision for advance directives, though the consultation notes its principles should mean an advance directive carries considerable force as evidence of the person’s wishes. The same document contrasts that with the rest of the UK, where provision is made in statute. So for Scotland: the age-18 statutory condition, the valid-and-applicable test, the four life-sustaining-treatment formalities and the Mental Capacity Act 2005 itself all do not apply. Do not use the England & Wales wording in Scotland.
  • Northern Ireland is separate again. The Department of Health there publishes its own review of the law relating to advance decisions to refuse treatment, examining the current legal position in Northern Ireland, and its advance care planning policy “Advance Care Planning: For Now and For the Future” was launched on 19 October 2022, with an ADRT operational framework among the frameworks planned to support it. Northern Ireland’s substitute-decision route is an Enduring Power of Attorney covering property and affairs, registered with the Office of Care and Protection. We do not state the legal basis of NI advance decisions here because we could not verify it.
  • Republic of Ireland, USA, Australia, Canada. None of this applies. In the United States a “living will” or advance directive is state law and varies by state — see the US page linked at the foot of this one, and do not cross-apply the two.
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Please read: this document refuses treatment and can take effect when your life is at risk. Discuss it with your doctor and, where you can, with a solicitor in England or Wales before you sign it.

Long FAQ (advance decisions, England & Wales)

Tap to expand. Written in plain English for England & Wales.
1) Is a “living will” the same thing as an advance decision?
Yes — in England and Wales the NHS uses “advance decision”, “living will” and “ADRT” for the same document: a decision made now to refuse specific treatments in the future if you are unable to communicate your wishes.
2) Is it legally binding?
Yes, where it complies with the Mental Capacity Act, is valid, and applies to the situation. In that case it takes precedence over decisions made in your best interests. Fail either half of “valid and applicable” and it does not bind.
3) Can I use it to ask for a particular treatment?
An advance decision works by refusing specific treatments — that is what the NHS describes it as doing. If you want to record what you would prefer to happen, that belongs in an advance statement, which is not legally binding but must be taken into account.
4) What extra rules apply if I am refusing life-sustaining treatment?
Four, and they are cumulative: it must be written down, signed by you, signed by a witness, and it must state that the decision applies even if your life is at risk. Leaving out that last sentence is the commonest fatal mistake.
5) What has to be true for it to count as valid?
You must have been aged 18 or over and had the capacity to make, understand and communicate the decision when you made it; you must clearly specify which treatments you are refusing and explain the circumstances; it must be signed by you (and by a witness if you are refusing life-sustaining treatment); you must have made it of your own accord, without harassment by anyone else; and you must not have said or done anything since that contradicts it.
6) Does it need a notary, a solicitor, or registering somewhere?
No notary, no registration body, no fee and no compulsory solicitor appear anywhere in the NHS process — unlike a lasting power of attorney, which must be registered with the Office of the Public Guardian before it can be used. Legal advice is still worth having on a document this serious.
7) Who has to take notice of it?
Anyone making a decision on behalf of someone who lacks capacity must, where the decision is about medical treatment, consider any living will the person has made. Where the advance decision is valid and applicable, it takes precedence over a best-interests decision.
8) What is the difference between this and an advance statement?
An advance decision is legally binding and refuses named treatments. An advance statement sets down preferences, wishes, beliefs and values about your future care — it is not legally binding, but anyone making decisions about your care must take it into account. Most people benefit from having both.
9) I have a health and welfare LPA. Do I still need an advance decision?
They do different jobs. An LPA appoints people to decide; an advance decision is your own refusal, fixed in advance. An LPA only reaches life-sustaining treatment if you chose Option A in section 5 of form LP1H. Where both documents exist and cover the same treatment, we do not state which prevails — that is a question for a solicitor.
10) Why might a clinician not follow mine?
The usual reason is that it is not applicable — the wording is too broad or too vague to tell whether it covers the actual circumstances. The fix is drafting: name the treatment, name the circumstances. The second reason is more mundane: nobody knew it existed.
11) Does this work in Scotland or Northern Ireland?
No. Scotland has no equivalent statutory regime — outside the narrow scope of the Mental Health (Care and Treatment) (Scotland) Act 2003, the common law prevails. Northern Ireland has its own position and its own advance care planning policy. Do not use England & Wales wording in either.
12) Can AI Lawyer draft one for me?
It can produce a structured draft on the Free Legal Starter plan — one document build — with each refusal set out against the circumstances it applies in, and the life-sustaining treatment requirements flagged. It is a starting point, not legal advice. Discuss it with your doctor and have it reviewed before you sign.
13) Can I speak to a lawyer confidentially about this?
Yes. Given what this document does, taking advice from a solicitor in England or Wales — alongside a conversation with your clinical team — is the sensible course.

 

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This is general legal information, not legal advice.