Advance Decision to Refuse Treatment UK: Living Wills Explained
Updated: 16 May 2026 • Reading time: 8 min
If you were to lose the ability to make decisions for yourself — through dementia, a stroke, or serious accident — who would decide what medical treatment you receive? Without an Advance Decision to Refuse Treatment (ADRT), doctors must act in your “best interests,” which may not align with your wishes. An ADRT — sometimes called a living will or advance directive — lets you make those choices now, when you have capacity, so they are legally binding later.
What the Mental Capacity Act 2005 Says
Sections 24–26 of the Mental Capacity Act 2005 give ADRTs statutory legal force in England and Wales. A valid and applicable ADRT must be followed by healthcare professionals — refusing to comply can expose them to legal liability. This is a fundamental shift from the pre-MCA position, where patients’ advance statements were influential but not binding.
An ADRT applies when:
- The person has lost mental capacity to consent to or refuse the treatment
- The specified treatment is being proposed
- The circumstances match those described in the ADRT
What an ADRT Can and Cannot Do
What It Can Do
- Refuse any medical treatment — antibiotics, surgery, blood transfusions, chemotherapy, dialysis
- Refuse cardiopulmonary resuscitation (CPR)
- Refuse artificial nutrition and hydration (ANH) — feeding tubes, IV drips
- Refuse mechanical ventilation
- Apply different decisions to different situations (e.g. refuse CPR if in a persistent vegetative state but not if in a recoverable condition)
What It Cannot Do
- Request a specific treatment (doctors are not obliged to provide treatments they consider inappropriate)
- Request euthanasia or assisted dying (currently unlawful in England and Wales)
- Refuse basic nursing care — keeping you clean, comfortable, and pain-free
- Be made by someone under 18
- Be made by someone who lacks capacity at the time of making it
Legal Requirements for a Valid ADRT
The validity requirements differ depending on whether the ADRT refuses life-sustaining treatment:
All ADRTs must:
- Be made by a person aged 18 or over
- Be made with mental capacity
- Specify the treatment to be refused
- Specify any circumstances in which the refusal applies or does not apply
ADRTs refusing life-sustaining treatment must additionally:
- Be in writing
- Be signed by the maker in the presence of a witness
- Have the witness sign in the maker’s presence
- Include the statement: “I refuse this treatment even if my life is at risk as a result”
An ADRT that refuses life-sustaining treatment without meeting these requirements is not legally binding — though it remains strong evidence of the person’s wishes that doctors should take into account.
ADRT vs Health and Welfare LPA
Many people make both an ADRT and a Health and Welfare LPA — they serve complementary but distinct purposes:
| Feature | ADRT | Health & Welfare LPA |
|---|---|---|
| What it does | Specifically refuses named treatments | Appoints someone to make all health decisions |
| Binding on doctors? | Yes (if valid and applicable) | Attorney has authority, within limits |
| Flexibility | Low — specific and pre-set | High — attorney can respond to circumstances |
| OPG registration needed? | No | Yes (£82 fee) |
| If they conflict | Most recently signed document prevails unless LPA expressly overrides | |
How to Make an ADRT
There is no official government form for an ADRT. Your document should include:
- Your full name, date of birth, and address
- A clear statement that this is an advance decision to refuse treatment
- The specific treatment(s) you are refusing
- The circumstances in which the refusal applies
- If refusing life-sustaining treatment: the statutory statement and signed witness requirements
- Your signature and the date
- Your witness’s full name, signature, and date
- A statement that you had capacity when you made it (optional but recommended)
Keep copies with your GP, any hospital treating you, your LPA attorney, and a trusted family member. The original should be accessible in a medical emergency — not locked away where it cannot be found.
Reviewing and Withdrawing an ADRT
You can withdraw an ADRT at any time while you have mental capacity — verbally, in writing, or by destroying the document. However, verbal withdrawals can be difficult to evidence in a medical emergency; a written withdrawal is preferable. If your ADRT refuses life-sustaining treatment, the withdrawal should also be written and witnessed to be beyond doubt.
Review your ADRT periodically — especially after a major health change, change of circumstances, or significant time has passed. An ADRT that is out of date may still be valid, but its applicability may be questioned if circumstances have changed markedly.
Frequently Asked Questions
What is an Advance Decision to Refuse Treatment?
An Advance Decision to Refuse Treatment (ADRT), sometimes called a living will or advance directive, is a legally binding document in which a person states in advance that they refuse a specific medical treatment if they later lose mental capacity and cannot consent or refuse at the time. The Mental Capacity Act 2005 (sections 24–26) gives ADRTs legal force in England and Wales — healthcare professionals must follow a valid and applicable ADRT.
What treatments can an ADRT refuse?
An ADRT can refuse any medical treatment — including antibiotics, blood transfusions, dialysis, resuscitation (CPR), ventilation, or artificial nutrition and hydration. However, it cannot be used to request a specific treatment (doctors are not obliged to provide treatments they judge unnecessary), and it cannot be used to refuse basic care such as keeping you comfortable, washing, or managing pain.
What are the legal requirements for an ADRT to be valid?
For an ADRT to be valid under the Mental Capacity Act 2005: (1) the person making it must be 18 or over; (2) they must have mental capacity when they make it; (3) it must specify the treatment to be refused; (4) if it refuses life-sustaining treatment, it must be in writing, signed by the maker in the presence of a witness, who also signs — and it must include the statement 'even if my life is at risk'. An ADRT that does not meet these requirements for life-sustaining treatment is not legally binding, though it may still be considered as evidence of the person's wishes.
How does an ADRT differ from a Health and Welfare LPA?
An ADRT and a Health and Welfare LPA serve different purposes. An ADRT is a specific, binding refusal of named treatments — healthcare professionals must follow it. A Health and Welfare LPA appoints an attorney to make decisions on your behalf, including about medical treatment — but the attorney decides within the bounds of your best interests and what powers you granted. An ADRT can coexist with an LPA, but if they conflict, the most recently signed document generally takes precedence (unless the LPA expressly states otherwise).
Can an ADRT be overridden?
A valid and applicable ADRT is legally binding and cannot be overridden by a family member, doctor, or even an attorney acting under a Health and Welfare LPA (unless the LPA expressly gives the attorney power to override it). However, if a healthcare professional has reasonable grounds to believe the ADRT may not be valid or applicable to the current situation, they should take steps to establish its validity before relying on it — and may act in the person's best interests in the meantime.
How do I make an Advance Decision?
There is no official form for an ADRT, but it should clearly state: your full name and date of birth; the specific treatments you refuse; the circumstances in which the refusal applies; if refusing life-sustaining treatment, the written and witnessed statement that you refuse 'even if my life is at risk'; your signature and date; and a witness's signature. Keep the original document in a safe place and give copies to your GP, any hospitals you attend regularly, and your next of kin or LPA attorney.
Complete Your Planning: Will + LPA + ADRT
A will, a Lasting Power of Attorney, and an Advance Decision together give you and your family comprehensive protection — for your assets, your health decisions, and your medical treatment. WillSafe helps you start with the will and guides you through what else you need.
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