Living Wills and Advance Decisions

A living will and an advance decision are the same thing. In England and Wales the legal term is an advance decision to refuse treatment, a written or spoken statement recording the medical treatments you would not want in future, which can be legally binding on your care team if it is valid and applies to your situation (NHS, as at July 2026, subject to change).

Many people think of it as the medical side of planning ahead, sitting alongside a will and a power of attorney rather than replacing them. This guide explains what an advance decision can and cannot do, the extra rules for refusing life-sustaining treatment, how it differs from an advance statement, and how it works with a health and welfare lasting power of attorney. It forms part of our wider estate planning guide. Rules described here are for England and Wales and are current as at July 2026.

What is a living will or advance decision?

An advance decision is a way to refuse named medical treatments ahead of time, so your wishes are known if you later lose the capacity to decide for yourself. It applies only to refusing treatment, not to demanding it, and it takes effect only once you can no longer make or communicate the decision in question (NHS, as at July 2026, subject to change).

The framework comes from the Mental Capacity Act 2005, which governs decisions made for people who lack capacity in England and Wales (legislation.gov.uk, sections 24 to 26, as at July 2026, subject to change). Where an advance decision is valid and applies to the treatment being considered, it generally has the same effect as a refusal made by a person with capacity, and it can be legally binding on the clinicians treating you.

Making an advance decision valid and binding

An advance decision only carries weight if it is both valid and applicable to the actual situation. Broadly, it must be made by someone aged 18 or over with capacity, made voluntarily, specify clearly which treatments are refused and in what circumstances, and not be overtaken by anything you later say or do (NHS, as at July 2026, subject to change).

Refusing treatment that could keep you alive brings stricter rules. Where an advance decision covers life-sustaining treatment, such as ventilation, resuscitation or antibiotics, it must be written down, signed by you and by a witness, and it must state clearly that it applies even if your life is at risk (NHS, as at July 2026, subject to change). Miss one of these and that part may not bind your care team, so many people choose to record it carefully and, where the stakes are high, discuss the wording with a qualified professional.

Source: NHS, advance decision to refuse treatment, reflecting the Mental Capacity Act 2005 (legislation.gov.uk), as at July 2026 and subject to change.

How it works with a lasting power of attorney

An advance decision and a health and welfare lasting power of attorney (LPA) can overlap, so the timing matters. A health and welfare LPA lets attorneys make care and treatment decisions once you lack capacity. If you make an LPA that gives attorneys authority over life-sustaining treatment after you have already made an advance decision, the later LPA can override the earlier refusal, so the order and wording need thought (NHS, as at July 2026, subject to change).

Because both tools turn on the question of mental capacity, many people look at them together rather than in isolation. It can be worth discussing with a qualified professional how an advance decision and an LPA should fit, so one does not accidentally cancel the other.

How to make one

There is no official form you must use, but a clear, well-recorded document is easier for a care team to follow. Many people set out the treatments they refuse, the circumstances, and, for life-sustaining treatment, the required signed and witnessed statement that it applies even if their life is at risk (NHS, as at July 2026, subject to change).

1. Decide what to refuse. Name the treatments and the situations in which you would not want them.
2. Meet the extra rules for life-sustaining treatment. Put it in writing, sign it, have it witnessed, and state it applies even if life is at risk.
3. Talk to your clinicians. Discussing it with your GP or medical team helps make sure it is clear and workable.
4. Share and store it. Give copies to your GP, family and anyone likely to be involved, and note where it is kept.
5. Review it. Revisit it after major changes in health or if you make a later power of attorney, as it can be withdrawn or altered while you have capacity (legislation.gov.uk, as at July 2026, subject to change).

An advance decision sits within wider planning, so many people prepare it alongside their How to Write a Will steps and their power of attorney, rather than as a stand-alone task.

Advance decisions in Scotland and Northern Ireland

The advance decision framework in the Mental Capacity Act 2005 applies to England and Wales, and its sections are marked as extending to those two nations (legislation.gov.uk, as at July 2026, subject to change). Scotland and Northern Ireland have their own capacity laws and their own approach to advance refusals of treatment, so the exact status and requirements can differ. Where care or treatment might straddle more than one UK nation, it can be worth taking advice locally. For the wider context, see our estate planning guide.

Frequently asked questions