Advance decisions and advance statements

An advance statement records how you would like to be looked after if you lose mental capacity. Anyone involved in your care should take it into account, but it is not legally binding.

An advance statement might include information about:

• where you want to be cared for
• what food and drink you like
• your habits – for example, whether you prefer baths or showers
• your beliefs and values, and how they affect your routine and care
• what you enjoy doing – like the type of music or TV programmes you enjoy
• who you want to be consulted about your care
• who can visit you
• anything you do not want to happen to you.

You do not have to use a particular form or template, but Compassion in Dying has a free advance statement template that can help you start. You do not have to sign your advance statement, but your signature will help to confirm that it represents your wishes.

Once you have written your statement, make sure you tell people it exists and where to find it. You could also give a copy to your GP to store with your medical records. You might also want to discuss it with family or friends. 

If someone holds power of attorney for you, make sure they have a copy. If someone has to decide what’s in your best interests, they must consider your advance statement.

These allow you to say which treatments you would want to refuse in certain situations if you didn’t have mental capacity. 

In England and Wales, the legal name is advance decision to refuse treatment (ADRT) – known as an advance decision. It is sometimes called a ‘living will’. In Scotland, it’s called an advance directive. 

In England and Wales, an advance decision is legally binding, but it must meet certain criteria. Once you have made an advance decision, doctors and healthcare professionals must follow it.

In Scotland, an advance directive is not legally binding, but if someone is making a decision for you, they have to take it into account. Advance directives are still widely recognised and used by healthcare professionals.

You can use an advance decision or directive to refuse any treatment. This includes life-sustaining treatment, such as:

• food and fluids given artificially – for example, through a drip
• ventilators to help you breathe
• CPR if your heart stops
• antibiotics for life-threatening conditions.

You cannot use it to:

• refuse basic care, such as being offered food or drink by mouth
• request particular treatments
• ask for your life to be ended.

You can use advance decisions/directives to state whether you would want to refuse treatments in all circumstances, or only in certain circumstances. 

An advance decision/directive can only be used if you lose the mental capacity to make or communicate your decisions.

There is no official form for writing an advance decision/directive. It doesn’t have to be in writing, unless you want to refuse potentially life-sustaining treatment.

If you want some help, Compassion in Dying has an online service you could use. You can also download or ask for a paper form. 

If you want to refuse life-sustaining treatment, you must use specific wording. Your advance decision/directive must also:

• be in writing
• be signed
• be witnessed by at least one person who isn’t your spouse, partner, civil partner or relative.

It’s important to tell people that you have made an advance decision/directive. It’s also a good idea to discuss your wishes with a GP or healthcare professional. They can help you to understand any risks and make sure your decision is clear. They could also confirm that you have the mental capacity to make your decision.

You should review your advance decision/directive regularly to make sure it still reflects what you want. Make sure you record any changes and let people (including your GP) know about them.

You may want to discuss your decision with family or friends, but the final decision is up to you.

You can change your mind at any time – both verbally and in writing – as long as you have mental capacity. If you cancel your advance decision/directive, make sure the original written document is destroyed. Tell everyone who knew about it that you have cancelled it. Healthcare professionals should make a note of this in your records.

You might want to give someone else the authority to make decisions about life-sustaining treatment for you. You can do this by setting up a power of attorney for health and welfare. 

In England and Wales, if you have both an advance decision and a power of attorney for health and welfare, the most recent one would be used if a decision about your health or care needed to be made. This would only apply to treatments or care that can be refused in an advance decision.

In Scotland, an advance directive isn’t legally binding, so a power of attorney for health and welfare would always override it. But an advance directive could help make sure that your attorney knows what you would want in particular situations.

You can have an advance statement and an advance decision/directive. They both help you to stay in control of your care if you lose mental capacity. The difference between them is that: 

• advance statements can include general information about your day-to-day care
• advance decisions/directives are used to refuse specific medical treatments. 

If you don’t have an advance decision/directive, an advance statement can still help people make decisions about your care and medical treatment that are in your best interests.

If you’re worried about your future care if you lose capacity, it’s a good idea to have both. Try to include as much information as possible about how you would like to be looked after.