Advance Decision (Living Will)

Author: Christopher Watts

Last verified: October 2025 (England & Wales)

When we plan for the future, most people think first about their Health & Welfare LPA — the document that appoints trusted people to act if capacity is ever lost. But there’s another powerful tool that works alongside it: the Advance Decision to Refuse Treatment (ADRT), often known as a Living Will.
Where your LPA gives authority to others, your Advance Decision gives direction from you. Together, they ensure clarity, confidence, and compassion in medical decision-making — and spare loved ones from impossible choices.

What an Advance Decision Does

An Advance Decision (or ADRT) is a legally binding document under the Mental Capacity Act 2005that lets you refuse specific medical treatments in defined circumstances, should you lose capacity to decide for yourself.

You can use it to:

Decline life-sustaining treatment such as CPR or ventilation.
Refuse certain interventions on religious or moral grounds.
Set clear limits for treatments that would only prolong suffering or loss of dignity.

It only comes into effect if you lose capacity, and it can be withdrawn or updated any time while you still have it.

How It Works with Your Health & Welfare LPA

Your Health & Welfare LPA appoints attorneys to act on your behalf. Your Advance Decision specifies what treatments you want to refuse.
Together they prevent confusion and protect both you and your attorneys.

A valid ADRT is binding on healthcare professionals and takes precedence if it clearly applies to the situation. However, if your LPA was made later and specifically authorises attorneys to decide about the same treatments, your attorneys’ decisions take priority. That’s why both should be written at the same time, checked for consistency, and registered together.When Fern Wills & LPAs prepare your documents, we help you:

Align both documents so they support each other.
Notify the Office of the Public Guardian (OPG) if an ADRT accompanies an LPA.
Keep copies with your GP and medical notes so professionals can find them quickly.

Advance Decision vs Advance Statement

An Advance Statement records your preferences, values, or beliefs but is not legally binding. Doctors and attorneys must take it into account, but they don’t have to follow it.

At Fern Wills & LPAs, we never produce Advance Statements as stand-alone documents. Instead, we build your preferences directly into your Health & Welfare LPA— either as:

Preferences, which guide your attorneys, or
Instructions, which bind your attorneys to your wishes.

If you’d like help identifying what to include, the Health Log and Welfare Log from our Life & Legacy Series make this process much easier. They help you record your beliefs, values, and practical care wishes, ensuring your LPA and Advance Decision reflect your true intentions.

How to Make an Advance Decision Valid

For your ADRT to be legally binding:

It must be in writing, signed, and witnessed.
If refusing 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 situations 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.

Real-Life Example: Why It Matters

Mrs Grant’s story illustrates why visibility and accuracy matter. She had a valid Advance Decision refusing artificial feeding after a severe stroke. Unfortunately, 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: a valid document is only helpful if it’s seen. Keep copies with your GP, your attorneys, and your medical notes — and note its existence in your Health Log or Welfare Log.

DNR and ReSPECT Forms — How They Fit In

DNACPR (Do Not Attempt CPR) forms are clinical decisions about resuscitation only. They are advisory unless also covered by a valid ADRT.
ReSPECT forms record medical recommendations and personal priorities. They guide clinicians but are not legally binding.
A valid Advance Decision remains the binding document for treatment refusals and can coexist with either form for clarity.

Frequently Asked Questions

Do I need both an Advance Decision and a Health & Welfare LPA?
They serve different purposes but complement each other. The LPA appoints your decision-makers; the ADRT records your personal treatment refusals.

Together they ensure full protection.

Can I update or cancel it later?
Yes — any time while you still have capacity. Simply destroy old copies and issue the updated version to your GP and attorneys.

Can my attorneys override my Advance Decision?
Not if it is valid and applicable, unless your LPA was created later and expressly grants that power.

Where should I keep it?
Keep one copy with your GP and one with your LPA papers. Note it in your Health Log or Welfare Log so your attorneys and family know it exists.

Is it the same as a DNR?
No. A DNR (Do Not Resuscitate) form only applies to CPR. An Advance Decision can cover CPR andother treatments.

Next Steps

If you already have a Health & Welfare LPA, adding an Advance Decision ensures that no situation is left unclear.
We’ll help you:

Clarify and document your treatment wishes.
Ensure both documents work together seamlessly.
Provide copies for your GP, attorneys, and care records.

Planning ahead means your values — not someone else’s guesswork — will guide your care.