Living Will (Advance Decision) UK 2026: How to Make One and What It Covers
Updated 15 May 2026 · 8 min read · England & Wales
A living will — formally called an Advance Decision to Refuse Treatment (ADRT) — lets you set out in advance which medical treatments you do not want if you later lose the mental capacity to refuse them yourself. In England and Wales, a valid ADRT is legally binding under the Mental Capacity Act 2005 — healthcare professionals must comply with it, even if following it means allowing you to die. It is entirely separate from a standard will, which deals with your assets after death.
Living will vs Health and Welfare LPA — key differences
| Feature | Living Will (ADRT) | Health & Welfare LPA |
|---|---|---|
| What it does | Refuses specific named treatments | Appoints an attorney to make welfare decisions |
| Can request treatment? | No — refusal only | Attorney can consent to or refuse treatment |
| Registration required? | No — no OPG registration, no fee | Yes — OPG registration, £82 fee |
| Flexibility | Fixed instruction — no judgment exercised | Attorney adapts to circumstances |
| Conflict rule | Valid ADRT overrides attorney for that treatment | Attorney acts across all health/welfare decisions |
Many people make both — an LPA for broad welfare decisions and an ADRT for specific treatments they know they want to refuse (such as CPR or long-term ventilation in advanced dementia).
What an ADRT can and cannot do
- Can refuse: CPR, mechanical ventilation, artificial nutrition and hydration (ANH), dialysis, blood transfusions, antibiotics (for a specific infection or condition), any other named treatment
- Cannot demand: specific treatment — there is no right to demand treatment a clinician considers inappropriate
- Cannot cover: financial matters (requires a Property and Financial Affairs LPA); assisted dying (unlawful in England and Wales); decisions in Scotland or Northern Ireland
Requirements for a valid ADRT for life-sustaining treatment
Under s25(5) Mental Capacity Act 2005, to refuse life-sustaining treatment an ADRT must:
- Be in writing
- Be signed by you (or by another person at your direction if you cannot sign) and by a witness
- Contain a statement that it applies even if life is at risk as a result
- Specify the treatment(s) being refused and the circumstances in which the refusal applies
For non-life-sustaining treatment, a verbal advance decision is recognised — but writing it down is always safer.
How to make a living will — practical steps
- Use a free template from Compassion in Dying or draft your own — no official form exists
- Specify each treatment you refuse and the circumstances that must apply (e.g. “if I have advanced dementia and can no longer recognise my family”)
- Include the words: “I intend this advance decision to apply even if my life is at risk as a result”
- Sign and date in front of a witness who also signs
- Give copies to: your GP (for your medical record), relevant hospitals, your next of kin, any LPA attorneys, and your solicitor
- Review and re-date every 1–2 years to confirm it remains current
When might an ADRT not be followed?
Healthcare professionals can decline to follow an ADRT if they have reasonable grounds to believe it is invalid, inapplicable, or was made under undue influence. Common reasons an ADRT may not apply:
- The circumstances described in the ADRT do not match the patient’s current situation
- A subsequent Health and Welfare LPA was made giving the attorney authority over the same treatment
- The patient took steps clearly inconsistent with the ADRT after making it
- The document is undated, unsigned, or lacks the life-risk statement for life-sustaining treatment
In genuine doubt, clinicians may apply to the Court of Protection for a declaration — in an emergency they will treat rather than wait.
Frequently asked questions
What is a living will and is it legally binding in England and Wales?
A 'living will' is the common term for an Advance Decision to Refuse Treatment (ADRT) — a written document in which you set out specific medical treatments you do not want if you later lose the mental capacity to make or communicate that decision yourself. In England and Wales, an ADRT is legally binding under the Mental Capacity Act 2005 (ss24–26): healthcare professionals and hospitals must comply with a valid, applicable advance decision, even if following it leads to your death. A verbal advance decision (not written) is also recognised under the Act but only for refusing treatments that are not life-sustaining — for life-sustaining treatment refusals (CPR, ventilation, artificial nutrition) the ADRT must be written, signed by you, and witnessed. An ADRT that is not valid and applicable is not legally binding, but must still be considered as evidence of your wishes.
What is the difference between a living will and a Health and Welfare LPA?
A living will (ADRT) and a Health and Welfare LPA are two different legal tools that serve different purposes: An ADRT is a direct instruction about specific treatments you do not want — it becomes legally binding without involving any other person to make the decision. It refuses treatment; it cannot request treatment or make general welfare decisions. A Health and Welfare LPA appoints a trusted person (your attorney) to make healthcare and welfare decisions on your behalf when you lack capacity — including decisions about medical treatment (unless you specify otherwise), where you live, and care arrangements. The attorney exercises judgment in the circumstances; the ADRT is a fixed instruction. Key practical differences: An ADRT requires no registration and has no fee; an LPA costs £82 to register. An attorney under an LPA can respond to circumstances an ADRT did not anticipate; an ADRT is more limited but harder to override. Many people make both — a Health and Welfare LPA for general welfare decisions, combined with an ADRT for specific treatments they want to refuse. If there is a conflict, a valid ADRT takes precedence over an attorney's wishes for the specific treatment it covers.
What can and cannot a living will (ADRT) cover?
An ADRT can: refuse any specific medical treatment, including life-sustaining treatment (CPR, mechanical ventilation, artificial nutrition and hydration, dialysis, blood transfusions, antibiotics for a specific condition); specify circumstances in which a refusal applies (e.g. 'if I have advanced dementia and cannot recognise my family'); take effect in advance of losing capacity. An ADRT cannot: demand specific treatment — a patient has no right to demand treatment a clinician considers inappropriate; consent to treatment on your behalf — it is a refusal tool only; make decisions about your finances or property — that requires a Property and Financial Affairs LPA; override a valid court order; apply in Scotland or Northern Ireland (different legal frameworks apply — seek local advice). An ADRT also cannot be used to request assisted dying, which remains unlawful in England and Wales.
How do you make a valid advance decision for life-sustaining treatment?
To make a valid and applicable ADRT refusing life-sustaining treatment, you must comply with s25(5) Mental Capacity Act 2005: (1) The ADRT must be in writing. (2) It must be signed by you (or by another person at your direction if you cannot sign — for example if you have a physical disability). (3) The signature must be witnessed by another person (not the same person who signs at your direction). (4) The document must contain a specific statement that the advance decision is to apply to the specific treatment even if your life is at risk as a result. There is no official form — you can use a free template from Compassion in Dying (myvoice.compassionindying.org.uk) or draft your own. You should also: date the document; specify the treatment(s) being refused; specify the circumstances in which it applies; state clearly that you had capacity when you made it; review and re-date it periodically (ideally every 1–2 years) to show it remains current.
What makes an advance decision invalid or inapplicable?
An ADRT is invalid if any of the following apply: (a) you have withdrawn it while you had capacity; (b) you have, since making the ADRT, made a Lasting Power of Attorney that gives your attorney authority to consent to or refuse the treatment in question (the LPA supersedes the earlier ADRT for that treatment — though this is debated if the ADRT was made later); (c) you have done anything clearly inconsistent with the ADRT — for example, consenting to the same treatment shortly before losing capacity, or taking steps that show the ADRT no longer reflects your wishes. An ADRT is inapplicable if: the specified circumstances do not match the patient's current situation; the treatment being proposed is different from the treatment refused in the ADRT; the ADRT does not specify that it applies even if life is at risk (where life-sustaining treatment is proposed). If healthcare professionals have reasonable doubt about validity or applicability, they can apply to the Court of Protection for a declaration — in an emergency, they will treat the patient rather than wait.
Do I need a solicitor to make a living will?
No — there is no legal requirement for a solicitor to make an ADRT. The Mental Capacity Act 2005 sets out the requirements and free, well-drafted templates are available from Compassion in Dying (myvoice.compassionindying.org.uk) and NHS trusts. However, solicitor input is advisable if: you have complex medical conditions and want tailored wording; you are concerned about family disputes; you also want to make a Health and Welfare LPA at the same time (which requires an OPG certificate provider or a solicitor). There is no registration process for an ADRT — unlike an LPA, it does not need to be sent to the Office of the Public Guardian. Once completed: give copies to your GP (ask them to add it to your medical records), any hospitals you regularly attend, your next of kin, your attorneys (if you have an LPA), and keep a copy in your home. Consider giving a copy to your solicitor or the person holding your will. Carry a card noting that you have an ADRT.
Can a living will be changed or cancelled?
Yes — you can change or cancel an ADRT at any time while you still have mental capacity. No special formality is required to cancel (revoke) it: you can destroy the document; you can make a new written statement that you are revoking it; or you can simply tell your healthcare team. However, if the ADRT is for life-sustaining treatment, a written withdrawal is strongly advisable to prevent any ambiguity. If you make changes, draft a new ADRT and give new copies to everyone who held a copy of the old version. Periodically reviewing and re-dating your ADRT (ideally every 1–2 years) demonstrates that it is current and reflects your present wishes — an outdated ADRT may be treated with less weight by clinicians even if technically still valid.
Plan ahead — make your wishes legally binding
A living will covers your medical wishes; a will covers your estate after death. WillSafe’s will kits come with plain-English guidance to help you plan both in one afternoon.
Get the Will Kit →Related guides
- Health and welfare LPA UK
- What is a lasting power of attorney UK?
- LPA and the Mental Capacity Act UK
- Power of attorney and dementia UK
- Court of Protection deputyship UK