What is an advance decision to refuse treatment in England and Wales?
An advance decision (sometimes called a living will or advance directive) is a legally binding document under the Mental Capacity Act 2005 that lets you refuse specific medical treatments in advance, in case you later lack the mental capacity to communicate your wishes.
What medical treatments can an advance decision cover?
An advance decision can refuse any specific treatment — for example antibiotics, resuscitation, artificial nutrition, or mechanical ventilation. It cannot be used to request a particular treatment or to authorise anything that is illegal. You must describe the circumstances in which the refusal applies.
What extra requirements apply if I want to refuse life-sustaining treatment?
To refuse life-sustaining treatment your advance decision must be written (not just verbal), signed by you in the presence of a witness, and contain a clear statement that the decision applies even if your life is at risk. The witness must sign to confirm they witnessed your signature.
Is an advance decision the same as a DNACPR notice?
No. A DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) notice is a clinical decision made by a doctor, often in discussion with you or your family. An advance decision is your own legally binding document. You can reference a wish not to be resuscitated in an advance decision, but a DNACPR must still be completed separately by a clinician.
How is an advance decision different from a Lasting Power of Attorney for health and welfare?
An advance decision lets you refuse specific treatments yourself. A Lasting Power of Attorney (LPA) for health and welfare appoints someone else — your attorney — to make decisions on your behalf. You can have both. An advance decision takes precedence over your attorney on any treatment it specifically refuses, unless the LPA was made after the advance decision and expressly overrides it.
Do I need to register an advance decision anywhere?
There is no formal register for advance decisions in England and Wales. You should give copies to your GP, any hospitals you regularly attend, and anyone who might be involved in your care. Your GP can add a note to your medical records. NHS England recommends keeping a copy in a visible place at home.
When does an advance decision take effect?
An advance decision only takes effect when you lack the mental capacity to make or communicate a decision about the specific treatment it covers. While you have capacity you can always accept or refuse treatment verbally. You can withdraw or amend your advance decision at any time while you have capacity.
Can an advance decision be challenged or overridden?
Healthcare professionals can challenge an advance decision if they have reasonable grounds to doubt its validity — for example if they believe you lacked capacity when you made it, or if circumstances have changed significantly. If there is doubt, they may apply to the Court of Protection. A valid and applicable advance decision is legally binding.
Does making an advance decision require a solicitor?
No. The Mental Capacity Act 2005 does not require a solicitor to create an advance decision. Organisations such as Compassion in Dying provide free advance decision templates for England and Wales. A solicitor can help ensure the document is clearly drafted, particularly if your situation is complex.
How does uplaw.ai help with an advance decision in England and Wales?
Tell uplaw.ai what treatments you wish to refuse and in what circumstances, and we will help you draft a clear, compliant advance decision document. We will also explain how it interacts with any LPA you hold and what steps to take to make sure healthcare professionals are aware of it.
Free to start
Want to make an advance decision? Tell uplaw.ai what you need.
No account required. uplaw.ai helps you draft a compliant advance decision and explains how to store and share it.