What is an Advance Decision or Living Will?

 

Thinking about your future care may feel difficult, but it’s one of the most empowering things you can do. If there ever comes a time when you can’t communicate your wishes, having a plan in place ensures your voice is still heard.

 

This article explains what an advance decision is, how it works, how it differs from other documents like an advance statement or Lasting Power of Attorney and how you can make one.

 

What Is an Advance Decision?

 

An advance decision, also known as a living will, is a legal document that lets you refuse specific medical treatment in the future.

 

It only applies if, at some point in the future, you lose the mental capacity to make or communicate decisions about your treatment. This could result from various causes, such as a serious accident, dementia, severe brain injury or a coma.

 

Advance decisions are recognised under the Mental Capacity Act 2005, and when made properly, they’re legally binding. That means healthcare professionals must follow your instructions.

 

 

 

What Treatment Can Be Refused?

 

You can use an advance decision to outline any medical treatment you’d like to refuse, including:

 

• CPR (cardiopulmonary resuscitation)
• Being put on a ventilator
• Artificial feeding through a tube
• Medications, like antibiotics, or blood transfusions

 

However, you can’t use an advance decision to:

 

• Request or demand specific treatments
• Ask for help to end your life (assisted dying and euthanasia are currently illegal in the UK)
• Refuse basic care like being kept clean

 

When Does It Take Effect?

 

Your advance decision only applies if both of the following are true:

 

1. You have lost the mental capacity to make or communicate decisions, and
2. The situation described in your advance decision has arisen (e.g. you're in a coma and need antibiotics, which you have previously refused in writing).

 

As long as you have capacity, you’ll continue to make your own decisions. Your advance decision simply comes into play if you ever lose that ability and it would take precedence over decisions made in your best interest by other people.

 

What Makes an Advance Decision Legally Binding?

 

For an advance decision to be legally binding under UK law, it has to comply with the Mental Capacity Act, be valid and apply to the situation.

 

An advance decision is only considered valid if:

 

• You’re aged over 18 and had the capacity to understand, make and communicate your decision when the advance decision was made
• You clearly state which treatments you would like to refuse and under what circumstances
• It’s signed by you (and also by a witness if you want to refuse life-sustaining treatment)
• You’ve made the advance decision of your own accord, without any pressure or harassment by anyone else
• You haven't said anything that contradicts the advance decision since you made it

 

If your advance decision includes a refusal of life-sustaining treatment like ventilation or resuscitation, there are additional legal requirements:

 

• It must be written down
• It must be signed and dated by you
• It must be witnessed and signed by them too
• It must include a statement to say that the decision applies “even if your life is at risk”

 

How Do I Make an Advance Decision?

 

You don’t need a solicitor to make an advance decision, and there’s no official form but it must be clear, specific and meet the legal requirements to be valid.

 

To make the process easier, it’s a good idea to use a pre-made template, like the one offered by Alzheimer's Society.

 

Before making the advance decision, you can discuss your wishes with your GP who can help you explain what treatments are involved and note your preferences in your medical records.

 

Once you’ve created your advance decision:

 

• Give a copy to your GP and ask them to keep it on file
• Share it with close family (or friends) who might be involved in your care
• Store a copy somewhere accessible at home
• Carry a small card in your wallet that says you have an advance decision and where to find it

 

 

What If I Have a Lasting Power of Attorney?

 

A lasting power of attorney (LPA) for health and welfare allows you to appoint someone you trust to make decisions on your behalf if you lose capacity.

 

If you have both an LPA and an advance decision, it’s important to make sure they don’t conflict. Here’s how they interact:

 

• If your advance decision was made after setting up an LPA, healthcare professionals must follow the advance decision even if your attorney disagrees
• If your LPA was made after the advance decision, your attorney can override it but only if they have the legal authority to decide on the same treatments you've refused

 

To clear up any confusion, speak to your attorney about your advance decision and review both documents together so they fully understand your values and preferences.

 

What Is an Advance Statement?

 

An advance statement includes general wishes and preferences you may have about your care, in case there comes a time when you’re unable to express your preferences.

 

Unlike an advance decision, it’s not legally binding but it should still be considered by healthcare professionals and others involved in your care.

 

It can include things like:

 

• Where you’d prefer to be cared for (e.g. at home or elsewhere)
• Your religious or cultural beliefs
• Your dietary requirements
• What kinds of clothes you like to be dressed in
• Whether you prefer showers or baths

 

Lots of people choose to complete both an advance decision and an advance statement to make sure all aspects of their care, medical and personal, are covered.

 

Can I Change or Cancel My Advance Decision?

 

Yes, you can change or cancel your advance decision at any time, as long as you still have mental capacity.

 

To update it, you can draft a new advance decision or make changes to the existing document and then sign and date it to confirm the changes.

 

Make sure you also inform your GP and anyone else who has a copy so they can discard the outdated version.

 

HelpAlert Support

 

At HelpAlert, we believe that peace of mind doesn’t just come from knowing your wishes are written down but from knowing help is always within reach.

 

Our personal alarm service offers 24/7 UK-based support, automatic fall detection and GPS tracking, so whether you live alone or with others, you can stay safe, independent and in control.

 

Not sure if it’s right for you? Try our free 14-day trial – no contracts, no pressure, just a small postage fee.

 

Explore our full range of features on our website or call our friendly team on 01273 055049.