Advance Decisions and Living Wills
An Advance Decision to Refuse Treatment (ADRT), sometimes called a living will or advance directive, is a legally binding document under the Mental Capacity Act 2005. It allows you to specify in advance which medical treatments you would refuse in specific circumstances, to take effect when you no longer have capacity to decide for yourself.
Key points
- An ADRT is legally binding if it is valid and applicable to the treatment proposed.
- It can only refuse treatment — it cannot demand treatment that a doctor does not consider clinically appropriate.
- For life-sustaining treatment, an ADRT must be in writing, signed, and witnessed.
- An ADRT can be changed or cancelled at any time while you have mental capacity.
What an ADRT Can and Cannot Do
An Advance Decision to Refuse Treatment allows you to refuse specific medical treatments in specific circumstances in advance. If valid and applicable, it must be followed by healthcare professionals — they cannot override it, even if they believe treatment would benefit you, unless the ADRT is not valid or not applicable to the current situation.
Examples of what an ADRT can cover include: refusing cardiopulmonary resuscitation (CPR); refusing artificial ventilation; refusing artificial nutrition and hydration (by tube or drip); refusing blood transfusions; or refusing specific medications or procedures.
An ADRT cannot: demand treatment that a doctor does not consider clinically appropriate; request anything that is illegal (such as assisted dying, which is not legal in England); or appoint someone to make decisions on your behalf — that is the role of a Lasting Power of Attorney for Health and Welfare. An ADRT operates even without an LPA in place.
Making a Valid ADRT
For an ADRT to be legally binding, it must be valid and applicable to the treatment proposed:
- You must be 18 or over and have capacity when making it;
- It must be specific — broad statements such as "I do not want aggressive treatment" are not an ADRT. You must specify the treatment(s) you are refusing and the circumstances in which you are refusing them;
- For life-sustaining treatment — the ADRT must be in writing, signed by you (or by someone at your direction if you cannot write), and signed and witnessed by another person who confirms you had capacity when making it. It must include a statement that the ADRT applies even if life is at risk;
- For other treatment — an oral ADRT may be binding, but a written one is strongly recommended to prevent disputes about what was said.
An ADRT is invalidated if: you have since consented to the treatment specified; you have done anything inconsistent with the ADRT (such as discussing a wish to have the treatment); or you have subsequently made an LPA for Health and Welfare granting the attorney authority over the treatment specified.
Making Your ADRT Known
An ADRT that no one knows about may not be found when it is needed. To make your ADRT effective:
- Give a copy to your GP to be included in your medical records;
- Give a copy to any hospital you attend regularly;
- Keep a copy at home where it can easily be found by family or emergency responders;
- Tell family members and close friends that it exists and where it is kept;
- If you receive regular care at home, ensure your care team know about it.
There is no central register for ADRTs in England — responsibility for ensuring it is known rests with you and your family. Some people wear a medical alert bracelet referencing their ADRT. Review and update your ADRT regularly to ensure it still reflects your wishes — an outdated ADRT may raise questions about whether it still represents your current views.
Frequently asked questions
What is the difference between an ADRT and an advance statement?
Can my family override my ADRT?
Does an ADRT work if I have an LPA for Health and Welfare?
What to do next
- 1Make an advance decision — guidance and templates
NHS guidance on advance decisions with template wording.
- 2
- 3
Official bodies and resources
National Health Service
GovernmentThe publicly funded healthcare system in the United Kingdom, providing free healthcare for all UK residents.
Age UK
CharityThe country's leading charity dedicated to helping everyone make the most of later life, providing advice, support, and companionship.
Citizens Advice
CharityProvides free, confidential, and independent advice on a wide range of issues including benefits, housing, debt, and employment.
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