Living Will UK: Advance Decision to Refuse Treatment (ADRT) — Complete Guide
A “living will” is the common name for an Advance Decision to Refuse Treatment (ADRT) in England and Wales. Made under the Mental Capacity Act 2005, it is a legally binding document that allows you to refuse specific medical treatments in advance — in case you later lose the capacity to communicate your wishes. If it is valid and applicable, clinicians are legally required to follow it.
The Legal Framework
Sections 24–26 of the Mental Capacity Act 2005 govern advance decisions to refuse treatment in England and Wales. The key principles are:
- A competent adult has the right to refuse any medical treatment, including life-sustaining treatment
- This right persists even after the person loses capacity — through an ADRT made while they had capacity
- A valid and applicable ADRT has the same legal force as a contemporaneous refusal by a competent patient
- Healthcare professionals who provide treatment that is refused by a valid ADRT commit an unlawful act
The ADRT is distinct from an advance statement of wishes (which records your preferences but is not legally binding) and from a Health and Welfare LPA (which delegates decision-making to an attorney). An ADRT is a direct refusal — it says “no” to specific treatments.
What You Can — and Cannot — Refuse
Can be refused
- ✓CPR (cardiopulmonary resuscitation)
- ✓Mechanical ventilation
- ✓Artificial nutrition via feeding tube
- ✓Artificial hydration
- ✓Antibiotics for specific infections
- ✓Dialysis (kidney treatment)
- ✓Blood transfusions
- ✓Surgical procedures
- ✓Chemotherapy
- ✓Hospital admission
Cannot be refused
- ✗Basic nursing care and hygiene
- ✗Oral hydration (drinking)
- ✗Palliative care and pain relief
- ✗Treatments not yet available when ADRT made
- ✗Illegal procedures
- ✗Anything clinicians are not obliged to provide
Life-sustaining treatment: additional requirements
An ADRT that refuses life-sustaining treatment (including CPR, ventilation, artificial nutrition, or any treatment that, without it, the person would die) must: (1) be in writing; (2) be signed by the person making it; (3) be signed by a witness; and (4) state explicitly that the refusal applies “even if my life is at risk.” Without these additional steps, an ADRT refusing life-sustaining treatment is not legally binding.
How to Make a Valid ADRT
Decide what you want to refuse
Think carefully about which treatments you would refuse and in what circumstances. Be specific — a vague refusal may not be applicable when needed. For example: 'I refuse CPR if I have a terminal illness and I am in a persistent vegetative state or have irreversible loss of consciousness.'
Write it down
There is no official form required. You can write the ADRT yourself, use a template from Compassion in Dying or your GP surgery, or instruct a solicitor to draft it. An ADRT refusing only non-life-sustaining treatment does not have to be written (it can be verbal), but a written document is strongly recommended in all cases.
Include the magic words for life-sustaining treatment
If refusing life-sustaining treatment, the document must state explicitly: 'I make this advance decision to refuse treatment knowing that this may result in my death' or similar words that make absolutely clear you understand the consequences.
Sign and witness the document
Sign and date the document. For life-sustaining treatment refusals: the signature must be witnessed by a named person who signs in your presence. The witness must be independent (not a clinician who may be involved in your care, and not a beneficiary of your estate, though this is not a strict legal requirement — good practice).
Inform your GP and family
Tell your GP, who can add the ADRT to your medical records and mark it as accessible in an emergency (e.g., via the NHS Summary Care Record). Give copies to family members or anyone likely to be involved in your care. Consider carrying a card in your wallet noting its existence.
ADRT vs Health and Welfare LPA: Which Do I Need?
| Feature | Living will (ADRT) | Health & Welfare LPA |
|---|---|---|
| What it does | Refuses specific treatments in advance | Delegates decisions to a trusted attorney |
| Legally binding? | Yes — clinicians must follow if valid and applicable | Yes — attorney has authority to make decisions |
| Registration required? | No — takes effect immediately | Yes — must be registered with OPG (£82, 8–20 weeks) |
| Cost | Free (using a template) | £82 OPG registration fee |
| Covers unanticipated decisions? | No — only specific treatments named | Yes — attorney can respond to new situations |
| If both exist | ADRT takes precedence for specific refused treatments | LPA attorney decides everything else |
Most people should have both: an ADRT covering specific treatments they are certain they would refuse, and a Health and Welfare LPA for the wider range of decisions that cannot be anticipated in advance.
Frequently Asked Questions
What is the difference between a living will (ADRT) and a lasting power of attorney for health and welfare?
A living will (ADRT) is a refusal document — it says 'I do not want treatment X in circumstances Y.' It is triggered automatically when the named circumstances arise and clinicians must follow it if it is valid and applicable. A Health and Welfare LPA is a delegation document — it gives attorneys the authority to make decisions on your behalf. Attorneys must act in your best interests, taking your previously expressed wishes into account, but they have decision-making power rather than a pre-specified instruction. If there is both a valid applicable ADRT and a Health and Welfare LPA, the ADRT takes precedence for the specific treatment it covers — the LPA attorney cannot override it. The two documents complement each other: an ADRT covers specific refusals you are certain about; an LPA covers the wider range of decisions that cannot all be anticipated in advance.
Is a living will legally binding in the UK?
Yes — an ADRT is legally binding under ss.24-26 Mental Capacity Act 2005 in England and Wales, provided it is valid and applicable. 'Valid' means it was made by a competent adult, was not subsequently revoked (including by a later inconsistent LPA), and the person had not done anything clearly inconsistent with it after making it. 'Applicable' means the specified treatment is now being proposed and the specified circumstances have arisen. If both conditions are met, clinicians are legally required to follow the ADRT — even if they disagree with the decision and even if following it may result in the patient's death. Ignoring a valid and applicable ADRT is a criminal offence under the MCA 2005.
What treatments can I refuse in a living will?
You can refuse any medical treatment in advance — including: CPR (cardiopulmonary resuscitation); mechanical ventilation; artificial nutrition and hydration (via tube); antibiotics for a specific infection; dialysis; blood transfusions; surgical procedures; chemotherapy. You can also refuse one treatment while accepting others (e.g., refuse CPR but accept pain relief). However, you cannot refuse: basic care and hygiene (washing, oral hydration); palliative care and pain relief (the law requires these to be offered); illegal treatments; anything that healthcare providers are not obligated to provide. An ADRT refusing life-sustaining treatment must be in writing, signed, witnessed, and explicitly state that it applies 'even if life is at risk.'
Do I need a solicitor or doctor to make a living will?
No — you do not need a solicitor or a doctor to make an ADRT. There is no registration requirement and no official form. You simply write the document yourself (or use a template), sign it, and have a witness sign it. If the ADRT refuses life-sustaining treatment, it must be in writing, signed by you, and witnessed. A doctor's signature is not required, though many people choose to inform their GP, who can add the ADRT to their medical records and ensure it is accessible in an emergency. There is no cost to making an ADRT — unlike LPA registration (£82 per LPA). Organisations including Compassion in Dying provide free ADRT templates.
Can I change or revoke my living will?
Yes — you can revoke or change an ADRT at any time while you still have mental capacity. Revocation can be verbal (telling healthcare professionals), written (destroying the document or writing a new one), or by conduct (doing something clearly inconsistent with the ADRT — for example, seeking the very treatment you said you would refuse). It is good practice to review your ADRT every few years or after a major change in health circumstances. After revoking, destroy all copies of the old ADRT and notify your GP and any family members who knew about it. If you are uncertain whether a new ADRT supersedes an old one, date the new document clearly and state it revokes all previous ADRTs.
Complete Your End-of-Life Planning
A living will (ADRT) covers what you refuse. A will covers what happens to your estate after death. An LPA covers financial and welfare decisions while you’re alive. Make the will now with WillSafe — the quickest step to take today.