How do I make an advance decision to refuse treatment?
Short answer
Set out clearly which treatments you refuse and in what circumstances. Where it covers life-sustaining treatment it must be in writing, signed and witnessed. Then make sure your GP, hospital and carers hold copies — an advance decision only works if the people treating you know it exists.
An Advance Decision to Refuse Treatment is legally binding under the Mental Capacity Act 2005 if it is valid and applicable to the treatment actually proposed. It takes effect only when you no longer have capacity to decide for yourself.
What it can and cannot do
An ADRT can refuse specified treatments — including life-sustaining treatment such as CPR or artificial ventilation — in circumstances you define. It cannot demand treatment a clinician does not consider clinically appropriate. For refusals of life-sustaining treatment there are formalities: the decision must be in writing, signed and witnessed.
Precision is what makes it work. Name the treatments and describe the circumstances in which the refusal applies. Vague documents tend to be treated as advance statements — a record of wishes that must be weighed in a best interests decision, but not binding.
Making sure it is followed
- Give a copy to your GP and ask for it to be recorded on your medical record.
- Give copies to your hospital team, care home or home care provider, and to family.
- For emergencies, it must be immediately accessible — carry a copy, and ask about a RESPECT form (Recommended Summary Plan for Emergency Care and Treatment), which clinicians complete with you and which is visible to emergency services.
- Review it after any significant new diagnosis, so it plainly covers your current condition. An ADRT written before a diagnosis may be judged not applicable to it.
Family, attorneys and changes of mind
A valid and applicable ADRT cannot be overridden by your family, though they can raise concerns with the clinical team about whether it is valid or applies, and a court can determine a genuine dispute.
The interaction with a health and welfare LPA is order-sensitive: an ADRT made before the LPA is generally displaced where the attorney has explicit authority over that treatment, while an ADRT made afterwards can override the attorney on the treatment it covers. If you have both, take legal advice and make the sequence clear on the face of the documents. You can change or cancel an ADRT at any time while you have capacity — tell everyone holding a copy when you do.
Related guides
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.
6 min
Lasting Power of Attorney
A Lasting Power of Attorney (LPA) is a legal document that lets you appoint one or more people (your 'attorneys') to make decisions on your behalf if you lose mental capacity in future. There are two types: one for property and financial affairs, and one for health and welfare. Making an LPA while you still have capacity is one of the most important planning steps you can take.
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End of Life Care Planning
End of life care planning means thinking and talking about how you want to be cared for in the final months, weeks, and days of life. Good planning can help ensure your wishes are known and respected, reduce distress for family members, and mean you are more likely to receive care that reflects your values and preferences.
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Mental Capacity Act Basics
The Mental Capacity Act 2005 (MCA) is the law that governs decisions made for people who lack the mental capacity to make specific decisions themselves. It applies to all adults in England and Wales and underpins how healthcare, social care, and legal decisions are made for vulnerable people.
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