Advance Decision (Living Will)
When we plan for the future, most people think first about a Health & Welfare LPA (Lasting Power of Attorney). That document appoints trusted people to make health, care and medical decisions if capacity is lost.
An Advance Decision to Refuse Treatment (ADRT), often called a Living Will, does something different. It records treatment refusals that come directly from you.
A Health & Welfare LPA gives authority to others. An Advance Decision gives direction from you. Used carefully, the two documents can reduce confusion for doctors, attorneys and family members at a very difficult time.
What an Advance Decision does
An Advance Decision, or ADRT, is a legally binding document under the Mental Capacity Act 2005. It lets you refuse specific medical treatments in defined circumstances if you later lose capacity to decide for yourself.
You can use it to:
• Refuse life-sustaining treatment such as CPR (Cardio Pulmonary Resuscitation), ventilation or artificial feeding, if the legal requirements are met.
• Refuse certain treatments on religious, moral or personal grounds.
• Set clear limits where treatment would only prolong suffering or loss of dignity.
It only applies if you lose capacity and the treatment refusal is valid and applicable to the situation. You can withdraw or update it at any time while you still have capacity.
How it works with your Health & Welfare LPA
Your Health & Welfare LPA appoints attorneys to make health, care and medical decisions if you lose capacity. Your Advance Decision records treatment refusals that you have chosen yourself.
The order matters.
If you make an Advance Decision after a Health & Welfare LPA, your attorneys cannot consent to a treatment that you have validly refused, if the Advance Decision applies to that situation.
If you make the Health & Welfare LPA after the Advance Decision, the LPA can override the Advance Decision for the same treatment decisions if you give your attorneys authority to make those decisions.
If you want both documents to work together, the LPA should refer to the Advance Decision in section 7. A copy of the Advance Decision should also be included when the Health & Welfare LPA is sent to the Office of the Public Guardian for registration, so the connection is clear.
Fern Wills & LPAs helps you:
• Align both documents so they support each other.
• Decide whether your LPA should refer to your Advance Decision.
• Include the right copy with the Health & Welfare LPA application where needed.
• Keep copies with your GP, attorneys and medical notes so professionals can find them quickly.
Advance Decision vs Advance Statement
An Advance Statement records your preferences, values or beliefs. It is not legally binding. Doctors and attorneys must take it into account, but they do not have to follow it.
Fern Wills & LPAs does not usually produce Advance Statements as separate stand-alone documents. Instead, we usually build your preferences directly into your Health & Welfare LPA as:
• Preferences, which guide your attorneys.
• Instructions, which bind your attorneys where the wording is valid and workable.
If you would like help identifying what to include, the Health Log and Welfare Log from our Life & Legacy Series can make this easier. They help you record your beliefs, values and practical care wishes, so your LPA and Advance Decision better reflect what matters to you.
How to make an Advance Decision valid
For an ADRT to be legally binding:
- It must be in writing, signed and witnessed.
- If it refuses life-sustaining treatment, it must include a statement that it applies even if your life is at risk.
- It must clearly describe which treatments are refused and the circumstances in which those refusals apply.
- You must not have done or said anything later that contradicts it.
We recommend reviewing and re-signing it every few years to confirm your ongoing wishes.
Case: why visibility matters
Mrs Grant had a valid Advance Decision refusing artificial feeding after a severe stroke. Her hospital misplaced it and continued treatment for 22 months against her wishes. After legal action, her family received a settlement, but her Advance Decision had not been followed.
The lesson is simple: a valid document only helps if people know it exists and can find it quickly.
Keep copies with your GP, your attorneys and your medical notes. You should also note its existence in your Health Log or Welfare Log.
DNR and ReSPECT forms: how they fit in
• DNACPR forms, sometimes called DNR (Do Not Resuscitate) forms, deal with CPR only. They are clinical decisions about resuscitation. They are not the same as a full Advance Decision.
• ReSPECT forms record medical recommendations and personal priorities. They guide clinicians but are not legally binding in the same way as a valid ADRT.A valid Advance Decision remains the binding document for treatment refusals if it applies to the situation.
FREQUENTLY ASKED QUESTIONS
Do I need both an Advance Decision and a Health & Welfare LPA?
They serve different purposes. The LPA appoints decision-makers. The ADRT records your own treatment refusals. Many clients use both, but the documents must be checked so they do not conflict.
Can I update or cancel an Advance Decision later?
Yes. You can update or cancel it at any time while you still have capacity. Old copies should be removed where possible, and updated copies should be sent to your GP, attorneys and relevant medical records.
Can my attorneys override my Advance Decision?
Not if it is valid, applicable and made after the LPA. If the LPA is made later and gives your attorneys authority over the same treatment decision, the LPA may override the earlier Advance Decision.
Where should I keep it?
Keep one copy with your GP and one with your LPA papers. Your attorneys and close family should know where it is. If it is linked to a Health & Welfare LPA, a copy should be sent with the LPA application where needed. document-storage
Is it the same as a DNR?
No. A DNR or DNACPR form deals with CPR. An Advance Decision can cover CPR and other specified treatments, provided it is valid and applicable.
Next Steps
If you already have, or are making, a Health & Welfare LPA, an Advance Decision can help make your treatment wishes clearer.
We can help you:
• Clarify and document your treatment refusals.
• Check that your LPA and Advance Decision work together.
• Refer to the Advance Decision properly in the LPA where needed.
• Provide copies for your GP, attorneys, care records and the Office of the Public Guardian where appropriate.
Planning ahead means your values, not someone else’s guesswork, guide your care.
This article is general information only, not individual advice.
If you would like help preparing one, see our Advance Decision (Living Will) service and fee page.
