Living Well at Home UKClear, practical guidance for later life
Nation-specific guidance

By Does Your Duck Quack

Living wills: advance decisions and advance statements

Understand advance statements and advance decisions to refuse treatment, including how legal rules and document requirements differ across the UK.

Checked: 12 October 2026 · Next review: 12 April 2027 · Applies to: UK, with nation notes
How this guide was prepared

Purpose: how to guidance · Level: detailed

Checked by: Does Your Duck Quack. Sources are linked below; seek professional advice for individual circumstances.

The short answer

What to do first

Understand advance statements and advance decisions to refuse treatment, including how legal rules and document requirements differ across the UK.

Start here: An advance statement can describe what matters, preferred care, faith or cultural needs, and people to involve. An advance decision to refuse treatment is more specific: it identifies treatment refused and circumstances in which the refusal applies. It cannot demand a particular treatment.

Visual guides

See the decision at a glance

Which document records what?
  1. Advance statementRecords wishes, values, care preferences and people the person wants involved.
  2. Advance decisionRefuses specified treatment in defined circumstances; it cannot demand treatment.
  3. DNACPR or ReSPECTRecords CPR decisions or emergency care recommendations; it is not an advance decision.
  4. Health attorneyCan make certain decisions if the person cannot, subject to the document and law.
Make a document usable
  1. 1. State the purposeDescribe the treatment or care choices the document is intended to cover.
  2. 2. Follow national lawIn England and Wales, life-sustaining treatment refusals need written, signed and witnessed wording.
  3. 3. Share current copiesGive copies to clinicians and chosen supporters; keep the current version accessible.
  4. 4. Review changed wishesUpdate or clearly withdraw an old document after a change in wishes or circumstances.

Scope of this guide

This guide helps you understand the options and questions to ask. It is not personal medical, legal or financial advice. Check the official sources for your nation and seek qualified help for high-stakes decisions.

Who this guide is for

Adults who want clinicians and trusted people to understand their future treatment wishes, and supporters helping them record those wishes clearly.

A “living will” usually means an advance decision to refuse specified medical treatment in defined circumstances. An advance statement records values and preferences; an advance decision refuses a specified treatment in defined circumstances and may have legal force. These are different from a power of attorney, DNACPR decision or emergency care plan. Use the law that applies where the person lives and seek legal or clinical advice if uncertain.

Practical steps

1. Decide what you want the document to do

An advance statement can describe what matters, preferred care, faith or cultural needs, and people to involve. An advance decision to refuse treatment is more specific: it identifies treatment refused and circumstances in which the refusal applies. It cannot demand a particular treatment.

2. Follow the correct legal formalities

In England and Wales, the Mental Capacity Act 2005 governs advance decisions. A refusal of life-sustaining treatment must be written, signed by the person or someone directed by them in their presence, witnessed, and include a statement that it applies even if life is at risk.

3. Consider a health and welfare attorney separately

A health and welfare power of attorney appoints someone to make certain decisions if the person cannot make them, subject to the document and law. It is not the same as an advance decision. In England and Wales, a valid applicable advance decision can take priority over an attorney’s decision for the treatment it covers, but legal details matter.

4. Keep emergency forms distinct

A DNACPR form concerns cardiopulmonary resuscitation if the heart or breathing stops; it does not mean refusing other care. ReSPECT or similar emergency plans record clinical recommendations and preferences where used. These are not substitutes for an advance decision.

5. Share, review and replace old copies

Give copies to the GP, relevant specialists, attorney and people the person chooses. Keep the original accessible and tell supporters where it is. Review after a diagnosis, treatment change, move to another nation or change of wishes. Withdraw or replace an old document clearly, and make sure clinicians know which version is current.

Questions and checks

Common questions

Does an advance statement have to be followed?

An advance statement records a person’s wishes and values, but it is different from a legally binding advance decision to refuse specified treatment. Clinicians should consider relevant wishes when making decisions, while also applying the law and clinical circumstances. Write it clearly, discuss it with the care team and say who should be involved.

Does a living will need to be signed and witnessed?

The requirements depend on where the person lives and what the document says. In England and Wales, a refusal of life-sustaining treatment under an advance decision has extra written, signature, witness and explicit-statement requirements under the Mental Capacity Act 2005.

Is an advance decision the same as a power of attorney?

No. An advance decision sets out a refusal of specified treatment in defined circumstances. A health and welfare power of attorney appoints someone to make certain decisions if the person cannot do so, under the relevant law and document. They can interact, so discuss both with a solicitor or clinician and state clearly which documents exist.

What is the difference between an advance decision and DNACPR?

An advance decision is made by a person to refuse particular treatment if its conditions are met. A DNACPR decision is a clinical recommendation about cardiopulmonary resuscitation only. It does not mean that other treatment or care should be withheld.

Before you act

Write down the outcome you want, the names and dates involved, and the evidence or documents you already have. Ask for important decisions, costs and next steps in writing. If information is unclear, ask which nation’s rules are being used and when the decision will be reviewed.

If there is a delay or disagreement

Keep a short factual record of calls, letters and missed actions. Ask for the responsible person, the written reasons, the complaints or review route and any deadline. Immediate health or safety risks should be escalated separately rather than waiting for a routine complaint.

Differences across the UK

This guide covers England and Wales. Scotland uses advance directives under a different legal framework; Northern Ireland law and practice differ. Seek nation-specific advice. The Mental Capacity Act 2005 applies in England and Wales. Scotland’s Adults with Incapacity framework and common law treat advance refusals differently; Northern Ireland currently relies on common law for advance decisions, alongside a partially commenced Mental Capacity Act (NI) 2016. These documents are legally sensitive: obtain nation-specific advice rather than copying an English form across borders.

Primary sources

The publisher checked this guide against the 10 official sources below. This is an editorial source check, not approval by a clinician, lawyer or benefits adviser.

Editorial note: By Does Your Duck Quack.