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What is an advance decision?
An advance decision, also called an advance decision to refuse treatment, lets you say in advance which medical treatments you do not want in the future. It only applies if you later lose the ability to make or communicate your own decisions.
This can help if you want to plan for a time when you may be very ill, unconscious, or unable to understand what doctors are proposing. In England and Wales, a valid advance decision is legally binding in most cases.
Can you make one in the UK?
Yes, you can make an advance decision in the UK, but the rules differ slightly depending on where you live. The clearest legal framework applies in England and Wales under the Mental Capacity Act 2005.
In Scotland and Northern Ireland, advance decisions are not covered in exactly the same way, but your wishes can still be important when treatment decisions are being made. It is a good idea to get local legal or medical advice if you live there.
What can it cover?
An advance decision can refuse specific treatments, such as resuscitation, ventilation, antibiotics, or feeding through a tube. You can be as detailed as you want, as long as the decision is clear.
You can also choose to refuse treatment only in certain situations. For example, you might say that you do not want a treatment if your condition is terminal or if there is little chance of recovery.
How do you make it valid?
To make an advance decision valid, it must be written down if it refuses life-sustaining treatment. It should clearly state your name, the treatments you refuse, and the situations in which the refusal applies.
You must be an adult and have mental capacity when you make it. If the decision is about refusing life-sustaining treatment, you must also include a statement that it applies even if your life is at risk, and it should be signed and witnessed.
What should you do next?
It is sensible to talk to your GP, hospital team, or solicitor before completing an advance decision. They can help you make sure the wording is clear and that it reflects your wishes accurately.
Keep copies in places people are likely to find them, and give one to your family or anyone involved in your care. You should also review it regularly, especially if your health or views change.
Advance decisions and other choices
An advance decision is different from an advance statement. An advance statement records your preferences and beliefs, but it is not legally binding in the same way.
You may also want to make a lasting power of attorney for health and welfare. This lets someone you trust make decisions for you, which can work alongside an advance decision in some situations.
Frequently Asked Questions
An advance decision about treatment UK is a legally binding statement, usually made by an adult with capacity, saying which medical treatments they want to refuse in the future if they lose the ability to make or communicate decisions at that time.
Any adult in the UK with mental capacity can make an advance decision about treatment UK, as long as they understand the decision they are making and its likely effects.
An advance decision about treatment UK can refuse specific medical treatments, such as certain medicines, surgery, life-sustaining treatment, or other interventions, but it cannot demand treatment that doctors are not willing or able to provide.
Yes, an advance decision about treatment UK can refuse life-saving treatment, including treatment needed to keep someone alive, but this refusal must meet the legal requirements and be clearly written and applicable to the situation.
An advance decision about treatment UK should be in writing if it refuses life-sustaining treatment. For other refusals, writing is strongly recommended because it helps prove the decision and avoid confusion.
An advance decision about treatment UK does not always need witnesses, but if it refuses life-sustaining treatment, it must be in writing, signed, and witnessed, with the witness also signing the document.
An advance decision about treatment UK is a legal refusal of specific treatments, while an advance statement is a more general expression of wishes and preferences that is not usually legally binding.
Yes, an advance decision about treatment UK can be changed or cancelled at any time while the person still has mental capacity, as long as the change or cancellation is communicated clearly.
An advance decision about treatment UK takes effect only when the person lacks capacity to make or communicate the treatment decision at the time the treatment is proposed.
An advance decision about treatment UK may not be valid if the person had capacity problems when making it, if it is not applicable to the current treatment situation, if it has been withdrawn, or if later actions are inconsistent with it.
Yes, if an advance decision about treatment UK is valid and applicable, healthcare professionals must follow it and cannot lawfully give the refused treatment.
An advance decision about treatment UK can sometimes refuse certain treatments, but it cannot be used to refuse treatment under the Mental Health Act in all circumstances, especially where that Act allows treatment to be given despite the refusal.
No, family members cannot override a valid and applicable advance decision about treatment UK, although they may help doctors understand the person’s wishes and whether the document still applies.
An advance decision about treatment UK should be kept somewhere easy to find, and copies can be shared with family, carers, GPs, hospitals, and anyone likely to be involved in treatment decisions.
Yes, discussing an advance decision about treatment UK with a doctor or other healthcare professional is wise because they can explain the medical implications and help make sure the wording is clear and practical.
Yes, an advance decision about treatment UK can refuse antibiotics, pain relief, or other specific medicines if they are clearly identified in the document and the refusal is valid and applicable.
An advance decision about treatment UK only applies if the current treatment is the one described, or falls clearly within the refusal. If the situation is materially different, the decision may not apply.
If there is no advance decision about treatment UK and the person lacks capacity, healthcare professionals will make decisions based on the person’s best interests, considering any known wishes, beliefs, and values.
An advance decision about treatment UK can exist alongside a lasting power of attorney, but the documents must be consistent. If a health and welfare attorney has authority over the same issue, that may affect how the decision is applied.
An advance decision about treatment UK can last indefinitely unless it is changed, cancelled, or becomes invalid because circumstances, treatment options, or the person’s own later actions make it no longer applicable.
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