What treatments can be covered by an Advance Decision?

The document should clearly name the treatment, such as CPR, ventilation, artificial nutrition and hydration, antibiotics, surgery, blood transfusion, or dialysis, and state the circumstances in which each refusal applies. General or vague refusals may be harder to rely on.

Should an Advance Decision describe specific medical circumstances?

Yes. Circumstances are essential because a refusal only applies if the actual situation matches what the document describes. Common examples include terminal illness, permanent unconsciousness, advanced dementia, severe brain injury, or irreversible loss of capacity.

Does an Advance Decision need to be witnessed?

A witness is required where an Advance Decision refuses life-sustaining treatment because the document must be signed and witnessed. Although not always legally required for other refusals, witnessing helps evidence authenticity and reduce disputes.

Can I change or cancel an Advance Decision?

Yes. You can update or revoke an Advance Decision at any time while you have mental capacity. Revocation can be written, verbal, or by conduct, but written updates are safer and should be shared with your GP, family, attorneys, and care providers.

What supporting sections should be included in an advance healthcare directive?

Important supporting sections may include personal details, GP and emergency contacts, values and beliefs, organ donation wishes, palliative care preferences, document review dates, and where copies are stored. These sections help clinicians interpret and locate the directive.

Can an Advance Decision request specific treatment?

No. An Advance Decision can only refuse treatment. It cannot demand treatment, request assisted dying, require unlawful acts, or force clinicians to provide treatment they consider clinically inappropriate. Preferences for care can be included separately but are not binding in the same way.

Are doctors legally bound by an Advance Decision?

Healthcare professionals are legally required to follow a valid and applicable Advance Decision in England and Wales. If there is doubt about validity, applicability, capacity, or later contradictory behaviour, clinicians may need to assess the position before relying on it.

Does an Advance Decision apply across Britain?

The Mental Capacity Act 2005 governs Advance Decisions in England and Wales. Scotland and Northern Ireland have different legal frameworks and terminology, so documents intended for use there should be tailored to the relevant jurisdiction.

Where should I keep my Advance Decision?

The document should be stored somewhere accessible and copies should be given to your GP, hospital team, care home, close family, and any health and welfare attorney. It is also useful to carry an alert card stating that an Advance Decision exists.

How often should an Advance Decision be reviewed?

Regular review is not a strict legal requirement, but it helps show that your wishes remain current. Many people review their Advance Decision every one to two years, or after a major diagnosis, treatment change, relationship change, or move into care.

Why are clauses and sections important in an Advance Decision?

Clause guidance helps you understand what each section of an Advance Decision is for, what wording may be needed, and how to make refusals clear, valid, and applicable. It is especially important where life-sustaining treatment is being refused.

EN-GB>Wills>Advance Decision>Advance Healthcare Directive Clauses In Britain

Advance Healthcare Directive Clauses And Sections In Britain

Created: 11 Jun 2026

Explore key clauses and sections used in advance healthcare directives and why they matter. This structured dataset helps you understand common wording, compare provisions, and make more informed planning decisions. For related resources, visit AI Generated British Advance Decision.

Clause name	Purpose	Relevant to life sustaining treatment refusal	Drafting note
Personal details
Full Name And Identity Details	Identifies the person making the Advance Decision.	true	Include full name, date of birth, NHS number if known, and current address.
Current Address And Contact Details	Helps clinicians match the document to the correct patient.	true	Add residential address, telephone number, email, and any previous names.
Date Of Birth	Provides a key identifier for healthcare records.	true	Use day, month, and year to reduce risk of misidentification.
NHS Number	Links the Advance Decision to NHS clinical records.	false	Include the NHS number if known do not delay signing solely to find it.
Statement of understanding
England And Wales Jurisdiction Statement	States the document is intended as an Advance Decision under the Mental Capacity Act 2005.	true	Use where the maker is in England or Wales or wants the document governed by that framework.
Capacity At Time Of Making	Records that the maker has capacity when making the refusal.	true	State that the maker understands the nature and consequences of the decision.
Understanding Of Consequences	Shows the maker understands the effect of refusing treatment.	true	Mention discussion with a clinician if one occurred and note likely outcomes.
Free And Voluntary Decision	Records that the decision is made without pressure or coercion.	true	State that the maker has not been pressured by family, carers, or professionals.
Treatment refusal
Circumstances In Which Refusal Applies	Defines when the specified refusal is to operate.	true	Describe clinical situations clearly, such as permanent unconsciousness or advanced dementia.
Specific Treatment Refused	Identifies the treatment the maker refuses in advance.	true	Name each treatment rather than using only broad wording where possible.
Treatment refusal, Life-sustaining treatment wording
Refusal Of Cardiopulmonary Resuscitation	Refuses attempted CPR in specified circumstances.	true	State whether CPR is refused only in defined conditions or in all future circumstances.
Refusal Of Artificial Ventilation	Refuses mechanical ventilation or breathing support in specified circumstances.	true	Specify invasive ventilation, non-invasive ventilation, or both, if intended.
Refusal Of Artificial Nutrition And Hydration	Refuses clinically assisted feeding or fluids in specified circumstances.	true	Use precise wording for tube feeding, intravenous fluids, or clinically assisted nutrition and hydration.
Refusal Of Dialysis	Refuses kidney dialysis in specified circumstances.	true	State whether refusal covers starting dialysis, continuing dialysis, or both.
Treatment refusal
Refusal Of Antibiotics For Life-Threatening Infection	Refuses antibiotics where infection occurs in specified end-of-life conditions.	true	Clarify whether comfort-focused antibiotics remain acceptable.
Refusal Of Blood Transfusion	Refuses transfusion of blood or blood products.	true	List any acceptable blood fractions or alternatives if relevant.
Refusal Of Surgery Or Invasive Procedures	Refuses specified operations or invasive interventions.	false	Identify procedures and circumstances avoid refusing routine comfort measures unintentionally.
Refusal Of Chemotherapy Or Cancer Treatment	Refuses specified cancer treatments in defined circumstances.	false	State whether the refusal covers curative, palliative, or experimental treatment.
Refusal Of Intensive Care Admission	Refuses ICU-level treatment in stated circumstances.	true	Specify which ICU treatments are refused rather than refusing location alone.
Palliative Care Not Refused	Confirms comfort care, pain relief, and symptom control are still wanted.	false	State that refusal of treatment does not refuse pain relief, nursing care, or hygiene.
Basic Care Not Refused	Clarifies that ordinary care and comfort measures remain accepted.	false	Mention warmth, hygiene, mouth care, food and drink by mouth if safe, and pain relief.
Emergency Treatment Pending Assessment	Allows urgent steps while validity and applicability are checked.	false	Acknowledge that clinicians may give emergency treatment while locating or verifying the document.
Pregnancy Circumstances	States whether refusals apply if the maker is pregnant.	true	Include clear instructions if pregnancy would change the maker's decision.
Statement of understanding
Refusal Takes Effect When Capacity Is Lost	Confirms the refusal is intended to operate only if capacity is later absent.	true	State that the maker can decide for themselves while they have capacity.
Life-sustaining treatment wording
Applies Even If Life Is At Risk	Includes the required statement for refusing life-sustaining treatment.	true	Use clear words that the refusal applies even if life is at risk.
Life-sustaining treatment wording, Witnessing and signature
Written Form For Life-Sustaining Refusal	Records that the life-sustaining treatment refusal is in writing.	true	Ensure the refusal is contained in the signed written document, not only discussed orally.
Witnessing and signature
Maker Signature	Shows the maker has signed the Advance Decision.	true	Include signature, printed name, date, and place of signing.
Signature By Another Person At Direction	Allows signing by another person in the maker's presence and at their direction.	true	Record why another person signed and that the maker directed the signature.
Witness Signature	Evidences witnessing of the maker's signature or directed signature.	true	Add witness name, address, signature, date, and statement of witnessing.
Independent Witness Details	Supports reliability of the signature and reduces later disputes.	true	Prefer an adult independent witness who is not pressuring or benefiting from the decision.
Date Of Signing	Shows when the Advance Decision was made or confirmed.	true	Use a single clear date and avoid undated amendments.
Statement of understanding
Clinical Discussion Record	Records medical advice considered when making the document.	false	Name the GP or consultant, date of discussion, and key points understood.
Health And Welfare LPA Compatibility	Clarifies the relationship with any health and welfare attorney authority.	true	State whether any LPA exists and whether it was made before or after this document.
No Later Inconsistent Decision	Helps show the Advance Decision has not been withdrawn or overridden.	true	Confirm there is no later statement, conduct, or LPA authority inconsistent with the refusal.
Review and updates
Right To Withdraw While Capacitous	States the maker may withdraw the Advance Decision while they have capacity.	false	Explain that withdrawal can be made later and should be communicated clearly.
Regular Review Schedule	Shows the document remains current and considered.	false	Include review intervals, such as annually or after major health changes.
Review and updates, Witnessing and signature
Review Confirmation Signature	Records that the maker has reviewed and confirmed the document.	false	Add review date, maker signature, and witness signature if practical.
Review and updates
Amendments And Replacement Versions	Prevents confusion between old and new versions.	false	Avoid handwritten changes sign a replacement document and destroy superseded copies.
Review After Health Or Life Changes	Prompts review when circumstances may affect the maker's wishes.	false	List diagnosis, treatment change, hospitalisation, care move, relationship change, or new LPA.
Communication and copies
Copy To GP	Helps ensure the Advance Decision is noted in primary care records.	false	Name the GP practice and request that a copy is added to the medical record.
Copy To Hospital Or Specialist Team	Alerts treating specialists to treatment refusals relevant to future care.	false	List consultant, clinic, hospital, or community team receiving a copy.
Copy To Care Home Or Carers	Ensures day-to-day carers know the document exists.	false	Identify the care provider and where the copy should be stored.
Notification To Health And Welfare Attorneys	Informs attorneys of treatment refusals and document location.	false	List attorney names, contact details, and whether they hold a registered LPA.
Family And Emergency Contact Notification	Reduces delay and dispute by identifying people who know about the document.	false	Include names, relationships, phone numbers, and whether each person has a copy.
Location Of Original Document	Helps clinicians or relatives locate the signed original quickly.	false	State the storage place and who can access it in an emergency.
List Of Copy Holders	Shows who has received the Advance Decision.	false	Record names, roles, addresses or emails, and date sent.
Electronic Record And Digital Copy	Encourages accessible digital storage alongside paper copies.	false	Note if a scanned copy is held by GP, hospital, attorney, or secure cloud account.
Wallet Card Or Emergency Notice	Alerts emergency staff that an Advance Decision exists.	false	Include maker name, emergency contact, GP, and location of the signed document.
Ambulance And Emergency Services Information	Helps emergency responders identify refusals relevant to urgent treatment.	false	Ask the GP or care team about local electronic palliative care or urgent care records.
Communication and copies, Treatment refusal
Relationship With DNACPR Form	Clarifies whether a separate DNACPR record exists or is requested.	true	State that the Advance Decision is distinct from, but may support, CPR planning.
Statement of understanding
Values And Reasons Statement	Explains the values behind the treatment refusals.	false	Keep separate from binding refusals and avoid unclear conditions.
Advance Statement Is Non-Binding	Distinguishes preferences from legally binding treatment refusals.	false	Label wishes about place of care, visitors, or beliefs as preferences, not refusals.
No Request For Assisted Dying	Clarifies the document refuses treatment and does not request unlawful assisted dying.	false	State that the maker seeks lawful refusal of treatment, not active steps to cause death.
Mental Health Act Treatment Caveat	Notes limits where treatment is regulated by mental health legislation.	false	Include if the maker has relevant mental health history or wants to avoid overstatement.
No Demand For Specific Treatment	Confirms an Advance Decision refuses treatment and cannot require treatment.	false	Put treatment preferences in an advance statement or care plan instead.
Review and updates
Change In Circumstances Warning	Recognises that changed circumstances may affect applicability.	true	Review wording if treatments, diagnosis, prognosis, or personal wishes change.
Statement of understanding
If Validity Or Applicability Is Unclear	Acknowledges clinicians must consider validity and applicability before relying on refusal.	false	Name contacts who can confirm wishes, but do not give them power to alter the refusal.
Treatment refusal
Medical Conditions Covered	Links refusals to specified current or future medical conditions.	true	Use plain descriptions and clinical terms where known, such as MND, dementia, stroke, or cancer.
Treatment refusal, Life-sustaining treatment wording
Permanent Unconsciousness Or Coma Scenario	Applies refusals if recovery of consciousness is not expected.	true	Define who should assess prognosis, such as the responsible consultant and a second doctor.
Advanced Dementia Scenario	Applies refusals if dementia reaches a defined severe stage.	true	Describe functional triggers, such as inability to recognise family or swallow safely.
Terminal Illness Scenario	Applies refusals where illness is incurable and death is expected.	true	Define prognosis threshold if desired, such as days, weeks, or months.
Severe Stroke Or Brain Injury Scenario	Applies refusals after catastrophic neurological injury in defined circumstances.	true	Describe outcomes that would trigger refusal, such as permanent inability to communicate.
Treatment refusal
Severe Irreversible Suffering Scenario	Applies refusals where suffering is severe and cannot be acceptably relieved.	true	Define suffering carefully and include clinical assessment requirements where possible.
Statement of understanding
Religious Or Ethical Basis	Records beliefs relevant to the refusal, such as blood product decisions.	false	Keep belief statements concise and connect them to specific treatment refusals.
Statement of understanding, Witnessing and signature
Interpreter Or Communication Support Used	Shows communication support was provided when making the decision.	false	Record interpreter name, method used, and confirmation that the maker understood.
Statement of understanding
Capacity Assessment Attachment	Provides extra evidence of capacity where challenge is possible.	false	Consider a clinician note if the maker has cognitive impairment or complex refusals.
Binding Refusal Not Best Interests Preference	States that a valid and applicable refusal must be followed, not balanced as a preference.	true	Use for clarity where the maker wants binding refusal rather than general guidance.
Treatment refusal
Treatments Not Covered	Clarifies which treatments are not refused by the document.	false	List treatments the maker still accepts to reduce unintended broad interpretation.
Communication and copies
Organ Donation Compatibility	Notes whether refusals should be read consistently with organ donation wishes.	false	State whether short-term procedures for organ donation are accepted or refused.
Person To Contact About Wishes	Identifies someone who can explain the maker's wishes and document history.	false	Make clear the contact explains wishes only and does not override a valid refusal.
Statement of understanding
Scotland And Northern Ireland Caution	Warns that legal rules differ outside England and Wales.	false	Use jurisdiction-specific advice if the maker lives, receives care, or travels elsewhere in the UK.

What Clauses Make An Advance Decision Valid In England And Wales?

An Advance Decision to refuse treatment should clearly identify the maker, specify the treatment refused, and state the circumstances in which the refusal applies. If it refuses life-sustaining treatment, it must be in writing, signed by the maker or by someone at the maker's direction, witnessed, and include an express statement that the refusal is to apply even if life is at risk.

Which Clauses Are Most Important For Refusing Life-Sustaining Treatment?

Life-sustaining treatment wording is critical: the document should say the refusal applies even if life is at risk.
Specific treatment refusal clauses help avoid uncertainty by naming treatments such as CPR, ventilation, artificial nutrition and hydration, dialysis, antibiotics, or blood transfusion where relevant.
Witnessing and signature clauses are especially important because special formalities apply to life-sustaining treatment refusals.

How Should Copies And Communication Be Handled?

The document is more useful if it includes clauses for sharing copies with the GP, hospital team, care home, family members, attorneys under a health and welfare LPA, and emergency contacts. A clause stating where the original is kept can help clinicians find and rely on it quickly.

Why Should An Advance Decision Be Reviewed?

Regular review clauses help show that the decision still reflects the maker's wishes. A review is particularly useful after a new diagnosis, change in treatment options, hospital admission, care home move, marriage or civil partnership change, or creation of a health and welfare lasting power of attorney.

What Should Users Know About UK Differences?

The statutory Advance Decision rules in the Mental Capacity Act 2005 apply in England and Wales. Scotland and Northern Ireland use different legal frameworks and terminology, so a UK-facing document should make clear which jurisdiction it is intended for.

Advance Healthcare Directive Clauses and Sections

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FAQs

What is an advance healthcare directive in the UK?

An advance healthcare directive is commonly known in England and Wales as an Advance Decision to Refuse Treatment, or ADRT. It is a legal document that lets an adult refuse specified medical treatment in advance, in case they later lack capacity to decide.

What clauses are usually included in an Advance Decision?

What makes an Advance Decision legally valid?

What wording is needed to refuse life-sustaining treatment?

How is an Advance Decision different from a health and welfare LPA?

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