How do I refuse life-sustaining treatment in an Advance Decision?

To refuse life-sustaining treatment, the Advance Decision must be in writing, signed by you or someone signing at your direction, witnessed, and state that the refusal applies even if your life is at risk. Without these elements, it may not be binding for life-sustaining treatment.

Does an Advance Decision need to be signed and witnessed?

It is strongly recommended to sign and witness an Advance Decision, and it is legally required for refusals of life-sustaining treatment. A witness should be an independent adult who can confirm your signature.

Do I need to register my Advance Decision?

No, an Advance Decision does not need to be registered in England and Wales. To make it effective, give copies to your GP, hospital, care home, family, attorneys under any Lasting Power of Attorney, and keep one with your medical records.

What is the difference between an Advance Decision and a Lasting Power of Attorney?

An Advance Decision refuses specified medical treatment. A health and welfare Lasting Power of Attorney appoints attorneys to make health and care decisions for you if you lose capacity. If both exist, which one takes priority depends on timing and what powers were granted.

Can I change or cancel my Advance Decision?

Yes. You can withdraw or amend an Advance Decision at any time while you have capacity. Tell your doctors and anyone holding copies, destroy outdated versions, and issue a new signed document where needed.

When should I review my Advance Decision?

Review it regularly, especially after a diagnosis, hospital admission, change in treatment preferences, change in family circumstances, or creation of a Lasting Power of Attorney. A current document is easier for healthcare professionals to rely on.

Will doctors always follow my Advance Decision?

Doctors must follow a valid and applicable Advance Decision. If there is genuine doubt about its validity, applicability, or your capacity, they may provide treatment while the issue is assessed, often involving senior clinicians, family, attorneys or the Court of Protection.

What does it mean for an Advance Decision to be applicable?

Applicability means the Advance Decision matches the exact treatment and medical circumstances now arising. A refusal may not apply if the situation is materially different, new treatments exist, or the wording is too vague.

Where should I keep my Advance Decision?

Keep the original safe but accessible, and share copies with your GP, hospital specialists, care providers, close relatives, attorneys and anyone likely to be contacted in an emergency. Consider carrying an alert card stating that you have an Advance Decision.

Do I need a solicitor to make an Advance Decision?

You do not legally need a solicitor, but legal guidance can help if your circumstances are complex, you are refusing life-sustaining treatment, you have a Lasting Power of Attorney, or you want to reduce the risk of disputes.

EN-GB>Wills>Advance Decision>Advance Decision Questions | United Kingdom

Advance Decision Practical Questions In United Kingdom

Created: 12 Jun 2026

This guide answers practical questions about Advance Decisions in the United Kingdom, helping readers understand key choices, legal considerations, and real-world use. It complements our AI Generated British Advance Decision resources for clearer planning.

Question	Short answer	Professional advice may be helpful	Related topic
Making the document
What does an Advance Decision do?	It lets you refuse specified future medical treatment if you later lack capacity.	false	Advance Statement
Relationship with other documents
Is an Advance Decision the same as an Advance Statement?	No. An Advance Decision refuses treatment an Advance Statement records wishes and preferences.	false	Advance Statement
Making the document
Who can make an Advance Decision?	In England and Wales, adults aged 18 or over with capacity can make one.	false	Mental Capacity Assessment
Do I need mental capacity when I make it?	Yes. It is only valid if you had capacity when you made it.	true	Capacity Evidence Letter
Signing and witnessing
Does an Advance Decision have to be in writing?	It must be written if it refuses life-sustaining treatment writing is best for all refusals.	true	Life-Sustaining Treatment Refusal
Making the document
What wording is needed to refuse life-sustaining treatment?	It must state that the refusal applies even if life is at risk.	true	Life-Sustaining Treatment Refusal
Signing and witnessing
Do I need to sign my Advance Decision?	A life-sustaining treatment refusal must be signed by you or at your direction.	false	Witnessing An Advance Decision
Does my signature need to be witnessed?	Yes, if the decision refuses life-sustaining treatment.	false	Life-Sustaining Treatment Refusal
Who can witness an Advance Decision?	Use an independent adult witness who can confirm your signature.	false	Independent Witness
Making the document
Can I refuse all medical treatment in advance?	Broad refusals may be unclear specify treatments and circumstances as precisely as possible.	true	Treatment-Specific Refusals
Healthcare use
Can an Advance Decision refuse CPR?	Yes, but discuss CPR decisions with clinicians and ensure emergency records are updated.	true	DNACPR Decision
Making the document
Can I refuse artificial nutrition and hydration?	Yes, but this can be life-sustaining treatment and needs precise written wording.	true	Clinician Discussion
Healthcare use
Will an Advance Decision stop pain relief or comfort care?	Not unless you clearly refuse those treatments comfort care can still continue.	false	Palliative Care Preferences
Making the document
Can I use an Advance Decision to demand a treatment?	No. It can refuse treatment, not require doctors to provide a specific treatment.	false	Advance Statement
Can an Advance Decision ask for assisted dying?	No. It cannot require euthanasia, assisted dying, or unlawful treatment.	true	End Of Life Care Planning
Healthcare use
Can doctors treat me in an emergency before finding the document?	Yes, if they do not know a valid and applicable refusal exists.	false	Emergency Medical Records
Is an Advance Decision legally binding?	Yes, if it is valid, applicable, and meets any life-sustaining treatment formalities.	true	Medical Best Interests Decision
What does valid and applicable mean?	Valid means properly made and not withdrawn applicable means it fits the situation.	true	Treatment Circumstances
Changing or cancelling
Can my later behaviour invalidate my Advance Decision?	Yes. Clearly inconsistent later actions may make clinicians doubt it remains valid.	true	Document Review
Can I cancel an Advance Decision?	Yes. You can withdraw it at any time while you have capacity.	false	Revocation Notice
Can I cancel it verbally?	Yes, but written confirmation and notifying holders of copies is safer.	false	Revocation Notice
Should I update it after a new diagnosis?	Yes. Review it when your health, treatment options, or care setting changes.	true	Care Plan Review
How often should I review my Advance Decision?	Review it regularly and after major health, family, or legal changes.	false	Document Review Reminder
Sharing the document
Should I give a copy to my GP?	Yes. Ask your GP to add it to your medical record.	false	GP Medical Record
Should I give it to my hospital or specialist team?	Yes, especially if you have ongoing treatment or planned admissions.	false	Hospital Care Plan
Should my family know about my Advance Decision?	Usually yes, so they can tell clinicians and reduce disputes in an emergency.	false	Family Notification Letter
Should I carry a card saying I have an Advance Decision?	Yes. A wallet card or phone note can help emergency staff find it.	false	Emergency Contact Card
Do doctors need the original document?	A clear copy may help, but keep the signed original safe and accessible.	false	Document Storage
Should my care home have a copy?	Yes, if you live in or regularly use a care home or hospice.	false	Care Home Care Plan
Relationship with other documents
How does an Advance Decision affect a Health and Welfare LPA?	A later LPA may override it if attorneys are authorised for the same treatment.	true	Health And Welfare LPA
Can I make an Advance Decision after appointing attorneys?	Yes. A later valid refusal can limit attorney decisions about that treatment.	true	Health And Welfare LPA
Does a Property and Financial Affairs LPA affect medical decisions?	No. Medical decisions are dealt with by a Health and Welfare LPA or clinicians.	false	Property And Financial Affairs LPA
Should I make a Health and Welfare LPA as well?	Often yes, because attorneys can decide issues not covered by your refusal.	true	Health And Welfare LPA
Healthcare use
What happens if my Advance Decision does not cover the situation?	Clinicians or authorised attorneys decide in your best interests.	false	Best Interests Decision
Making the document
Can I include religious or personal reasons?	Yes, but put preferences in an Advance Statement and refusals in the Advance Decision.	false	Advance Statement
Can I refuse blood transfusions?	Yes. Identify the blood products refused and when the refusal applies.	true	Treatment-Specific Refusal
Can I refuse antibiotics in advance?	Yes, but specify the infections or circumstances where the refusal applies.	true	Treatment-Specific Refusal
Can I refuse ventilation or a breathing machine?	Yes. Because it may sustain life, use written, signed, witnessed wording.	true	Life-Sustaining Treatment Refusal
Can I refuse dialysis in advance?	Yes. State the kidney treatment refused and the clinical circumstances.	true	Renal Care Plan
Can I refuse surgery in advance?	Yes, but describe the type of surgery and situation clearly.	true	Surgical Consent
Can I make an Advance Decision after a dementia diagnosis?	Yes, if you still have capacity to make the specific decision.	true	Dementia Care Planning
What if my mental capacity fluctuates?	Make or review it when you have capacity and consider medical evidence.	true	Capacity Evidence Letter
Should pregnancy be mentioned in an Advance Decision?	Yes, if relevant pregnancy can affect whether a refusal is considered applicable.	true	Maternity Care Planning
Healthcare use
Can an Advance Decision refuse mental health treatment?	Sometimes, but Mental Health Act powers can override refusals in some cases.	true	Mental Health Crisis Plan
Does the Mental Health Act override an Advance Decision?	It can override refusals of treatment for mental disorder in certain circumstances.	true	Mental Health Act Advice
Making the document
Does the same law apply in Scotland?	No. Scotland uses advance directives under different legal rules.	true	Scottish Advance Directive
Does the same law apply in Northern Ireland?	No. Northern Ireland has different advance care planning rules and terminology.	true	Northern Ireland Advance Care Planning
Does an Advance Decision work in Wales?	Yes. The Mental Capacity Act rules apply in England and Wales.	false	England And Wales Advance Decision
Changing or cancelling
Should I review it if I move to Scotland or Northern Ireland?	Yes. Get local advice because the legal framework differs across the UK.	true	Cross-Border Care Planning
Healthcare use
Will my Advance Decision be recognised abroad?	Not necessarily. Local law and emergency practice may differ.	true	Travel Medical Planning
Does it apply while I still have capacity?	No. While you have capacity, you make current treatment decisions yourself.	false	Current Consent To Treatment
Making the document
Can someone make an Advance Decision for me?	No. It must be your own decision, made while you have capacity.	true	Health And Welfare LPA
Signing and witnessing
Can my attorney sign my Advance Decision for me?	Only if signing at your direction the treatment refusal must still be yours.	true	Signature At Direction
Can I sign an Advance Decision electronically?	Use a wet signature where possible, especially for life-sustaining treatment refusals.	true	Execution Formalities
Should I date my Advance Decision?	Yes. Dating it helps clinicians identify the latest valid document.	false	Document Version Control
Changing or cancelling
What if there are several versions?	Revoke old versions and circulate the newest signed copy clearly.	false	Revocation Notice
Sharing the document
Should my solicitor keep a copy?	It can help, but medical teams also need fast access to a copy.	false	Document Storage
Healthcare use
What if my family disagrees with my Advance Decision?	A valid and applicable refusal should be followed despite family disagreement.	true	Family Discussion Letter
Can a court decide if an Advance Decision is valid?	Yes. Serious disputes may be referred to the Court of Protection.	true	Court Of Protection
What if doctors are unsure whether it applies?	They may treat while checking validity, applicability, and any urgent risks.	true	Clinical Ethics Review
Sharing the document
Should I list people to contact?	Yes. Include GP, attorney, next of kin, and where the original is kept.	false	Emergency Contacts
Making the document
Should I use medical terms in the document?	Use clear terms and ask a clinician to check treatment descriptions if unsure.	true	Clinician Review
Is saying no heroic measures enough?	Usually not. Vague phrases may not identify the treatment or circumstances.	true	Treatment-Specific Refusals
Healthcare use
Can it apply if I am unconscious?	Yes, if you lack capacity and the refusal fits the treatment and situation.	false	Emergency Care Planning
Can it apply during a temporary illness?	Only if the document clearly covers that treatment and temporary situation.	true	Treatment Circumstances
Relationship with other documents
Can I include organ donation wishes?	Yes, but also record your organ donation decision on the NHS register.	false	NHS Organ Donor Register
Is an Advance Decision the same as a DNACPR form?	No. A DNACPR is a clinical record about CPR only.	false	DNACPR Decision
How does it relate to a ReSPECT form?	ReSPECT records emergency care recommendations it can refer to your Advance Decision.	false	ReSPECT Form
How does it relate to an advance care plan?	An advance care plan is broader an Advance Decision is the legal refusal part.	false	Advance Care Plan
Making the document
Can a child make an Advance Decision?	The Mental Capacity Act Advance Decision rules apply to people aged 18 or over.	true	Child Medical Consent
Changing or cancelling
What if I change my mind before treatment?	If you have capacity, your current decision overrides the Advance Decision.	false	Current Consent To Treatment
Healthcare use
What if I cannot speak but still have capacity?	Clinicians should support communication capacity is not lost just because speech is impaired.	true	Communication Support Plan
Making the document
Should the document be in English?	For UK use, English is practical provide translations if needed for your care team.	false	Accessible Care Documents
Sharing the document
What if my GP record is not updated?	Follow up in writing and give copies to other care providers directly.	false	GP Record Update Request
How can ambulance staff know about it?	Ask clinicians about local emergency care records, ReSPECT, or ambulance alerts.	false	ReSPECT Form
Healthcare use
Can it refuse treatment after self-harm or attempted suicide?	This is complex and may raise capacity, applicability, and mental health law issues.	true	Mental Health Crisis Plan
Making the document
Can I refuse treatment if I am permanently unconscious?	Yes, but define the condition and treatments refused with clinical precision.	true	Neurological Care Planning
Can I limit refusals to terminal illness?	Yes. State what terminal illness means and which treatments are refused.	true	End Of Life Care Plan
Signing and witnessing
Can a family member witness my signature?	Avoid it if possible an independent witness reduces disputes.	false	Independent Witness
Can someone who inherits from me witness it?	Avoid it. Independence helps prevent allegations of pressure or conflict.	false	Independent Witness
Making the document
What if someone pressured me to make it?	Pressure can undermine validity get independent legal or medical advice urgently.	true	Safeguarding Advice
Do I need to understand the consequences of refusal?	Yes. Understanding relevant consequences is part of decision-making capacity.	true	Capacity Assessment
Should I talk to my doctor before signing?	Yes, especially for serious illness, complex treatments, or life-sustaining refusals.	true	Clinician Review
Do I need a solicitor to make an Advance Decision?	No, but legal advice helps where validity, capacity, or LPA issues are complex.	true	Legal Advice
Healthcare use
Can doctors ignore my Advance Decision?	They should not ignore a valid and applicable refusal, but may treat if unsure.	true	Clinical Dispute Resolution
Are clinicians protected if they follow it?	Yes, if they reasonably believe it is valid and applicable.	false	Clinical Governance
Can it require doctors to stop treatment already started?	If valid and applicable, a refusal can require treatment not to be continued.	true	Treatment Withdrawal
Relationship with other documents
Can I say where I want to be cared for?	Yes, but place-of-care wishes belong in an Advance Statement or care plan.	false	Advance Statement
Can I include funeral wishes?	Better keep funeral wishes in a separate letter or will-related document.	false	Funeral Wishes Letter
Is an Advance Decision part of my will?	No. A will deals with your estate after death, not medical refusals.	false	Will
Sharing the document
Should I store it with my will?	Do not rely on that alone clinicians need access before death.	false	Document Storage
Making the document
What personal details should it include?	Include full name, date of birth, address, NHS number if known, and contacts.	false	Emergency Contacts
Do I need to include my NHS number?	It is not essential, but it helps match the document to your records.	false	GP Medical Record
Can I refuse experimental treatment?	Yes. Define the treatment type and when you would refuse it.	true	Clinical Trial Preferences
Can I refuse participation in clinical trials?	Yes, but this is often better recorded as a preference as well.	false	Advance Statement
Can I give advance consent to future treatment?	An Advance Decision is for refusals consent issues are handled separately.	false	Health And Welfare LPA
Can it cover dental or routine medical care?	Yes, but it is mainly used for significant future medical treatment refusals.	false	Routine Care Preferences
Changing or cancelling
What if new treatments become available later?	Review wording so it remains applicable to current treatment options.	true	Clinician Review
Can I add review confirmations without rewriting it?	Yes, but major changes should be made in a new signed version.	false	Review Confirmation Note
Signing and witnessing
Should a doctor countersign it?	Not legally required, but it can support understanding and applicability.	false	Clinician Review
Should I get evidence of capacity?	Consider it if capacity may later be questioned.	true	Capacity Evidence Letter
How can I show the decision is voluntary?	Use an independent witness, discuss with a clinician, and record your reasons.	true	Safeguarding Advice
Changing or cancelling
Should I review it after marriage or divorce?	Yes, especially if contacts, attorneys, or family dynamics change.	false	Health And Welfare LPA Review
What should I do with old copies after cancelling it?	Destroy them where possible and tell everyone who received a copy.	false	Revocation Notice
Can I cancel only part of it?	Yes, but a new complete version is usually clearer.	true	Document Replacement
Relationship with other documents
What if I make an LPA after my Advance Decision?	A later Health and Welfare LPA may displace overlapping refusals if authorised.	true	Health And Welfare LPA
Sharing the document
Should my attorneys have a copy?	Yes. They need to know any treatment refusals that limit their decisions.	false	Health And Welfare LPA
Relationship with other documents
Can it decide social care arrangements?	No. Social care wishes should go in an Advance Statement or care plan.	false	Advance Statement
Making the document
Can it refuse food and drink by mouth?	It is mainly for medical treatment discuss eating and drinking support separately.	true	Eating And Drinking Care Plan
Can I refuse clinically assisted hydration?	Yes, but treat it as potentially life-sustaining and use precise wording.	true	Life-Sustaining Treatment Refusal
Healthcare use
Can it apply if I am in a coma?	Yes, if the coma scenario and refused treatments are covered.	true	Neurological Care Planning
Making the document
Can I make refusals for a severe stroke?	Yes. Describe the level of impairment and treatments you would refuse.	true	Stroke Care Planning
Can I make refusals for serious brain injury?	Yes. Define the clinical circumstances and life-sustaining treatments refused.	true	Neurological Care Planning
Can I refuse chemotherapy or radiotherapy?	Yes. Identify the treatment and circumstances, such as advanced or terminal disease.	true	Cancer Care Plan
Signing and witnessing
Is refusing CPR a life-sustaining treatment refusal?	Usually yes, so written, signed, witnessed wording is essential.	true	DNACPR Decision
What should the witness confirm?	That you signed, or someone signed for you, in the witnesss presence.	false	Witnessing An Advance Decision
Sharing the document
Should I keep a digital copy?	Yes, but ensure key people can access the signed version quickly.	false	Digital Document Storage
Should it be password protected?	Avoid access barriers for emergency use share access details with trusted contacts.	false	Emergency Access Plan
Making the document
Can I refuse sedating medication?	Yes, but specify the medication type and whether comfort care is still wanted.	true	Palliative Care Preferences
Can I refuse palliative sedation?	Yes, but discuss consequences with palliative care clinicians first.	true	Palliative Care Plan
Healthcare use
Can it apply if I temporarily lack capacity from medication or intoxication?	Only if the document clearly applies to that situation and treatment.	true	Treatment Circumstances
Relationship with other documents
Can I include body donation wishes?	Record this separately with the medical school it is not a treatment refusal.	false	Body Donation Consent
Does an Advance Decision apply after death?	No. It concerns treatment while you are alive and lack capacity.	false	Will And Funeral Wishes
Signing and witnessing
Should vulnerable adults get extra support before signing?	Yes. Independent advice can help show capacity and freedom from pressure.	true	Safeguarding Advice
Making the document
Can I refuse hospital treatment if I later have advanced dementia?	Yes, if you define advanced dementia, treatments, and circumstances clearly.	true	Dementia Care Planning
Can I refuse tube feeding if I later have advanced dementia?	Yes, but use life-sustaining treatment formalities and clinical wording.	true	Dementia Care Planning
Is it worth making one if I am healthy?	Yes, but it is most effective when tailored to realistic future scenarios.	false	Advance Care Planning
Sharing the document
Should paid carers know about it?	Yes, if they may call emergency services or support care decisions.	false	Care Plan
Making the document
Should I name specific conditions?	Yes, where possible conditions help show when the refusal applies.	true	Treatment Circumstances
Can I refuse intensive care treatment?	Yes. Specify ICU treatments such as ventilation, CPR, dialysis, or vasopressors.	true	ICU Treatment Refusal
Can I refuse drugs that support blood pressure in intensive care?	Yes. Name the treatment type and when the refusal should apply.	true	ICU Treatment Refusal
Relationship with other documents
Should I include my values and quality-of-life views?	Yes, but place them in an Advance Statement or separate preferences section.	false	Advance Statement
What if my Advance Statement conflicts with my Advance Decision?	A valid and applicable Advance Decision refusal carries stronger legal effect.	true	Advance Statement Review

How Should You Make An Advance Decision In The UK?

An Advance Decision is most useful when it clearly identifies the treatments you want to refuse, the circumstances in which the refusal applies, and is shared with people involved in your care. If it refuses life-sustaining treatment, it must be in writing, signed, witnessed, and include a statement that it applies even if life is at risk.

When Is Professional Advice Especially Important?

Legal or clinical advice is particularly helpful if the decision involves life-sustaining treatment, complex medical conditions, mental health treatment, pregnancy, conflict with family, or possible overlap with a Health and Welfare Lasting Power of Attorney.

Who Needs A Copy Of An Advance Decision?

Copies should normally be given to your GP, hospital team, care home, attorney under any Health and Welfare LPA, and close family or carers. Keeping an alert card or note with emergency contacts can help clinicians find it quickly.

Can An Advance Decision Be Changed Or Cancelled?

You can change or withdraw an Advance Decision while you have mental capacity. Reviews are sensible after a new diagnosis, hospital admission, pregnancy, major treatment change, or after making a Health and Welfare LPA.

How Does An Advance Decision Interact With Other Planning Documents?

An Advance Decision can be legally binding for refusals of treatment, while an Advance Statement records wishes and preferences. A Health and Welfare LPA may override or be limited by an Advance Decision depending on which was made later and what powers it gives.

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FAQs

What is an Advance Decision in the United Kingdom?

An Advance Decision, often called an advance healthcare directive or living will, is a legal document that lets an adult in England and Wales refuse specified medical treatment in the future if they later lack capacity. It must be clear about which treatments are refused and the circumstances in which the refusal applies.

Is an Advance Decision legally binding in the UK?

What can I include in an Advance Decision?

Who can make an Advance Decision?

What makes an Advance Decision valid?

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