When an advance decision form is completed, it is a legally-binding agreement in England and Wales that states what treatment you do or do not want should you become too incapacitated to make the decision due to physical or mental illness.

It is only binding if it is proven to have been made at a time when you were fit enough to make the decision and without interference from other people.

The form is also known as a living will in Scotland and is in contrast to an advance statement which is not legally binding.

An advance statement is merely a statement of your personal beliefs and values which health professionals can take into consideration when determining the best treatment for you in illness.

What an advance decision covers?

Other provisions that make an advance decision valid include:

  • Being over 18
  • Clearly identifiable requests in terms of treatment
  • An explanation of specific circumstances under which you would refuse treatment
  • Ensuring you do not say or do anything that could contradict your treatment requests

However, there are also a number of instances that an advance decision cannot cover which include:

  • Asking for assistance to commit suicide (euthanasia)
  • Any requests which are contrary to the law
  • Selecting someone to make treatment requests on your behalf

If you want someone to make decisions about your treatment on your behalf, then you must make a lasting power of attorney instead and this must be registered with the Office of the Public Guardian.

It is also worth noting that advance decisions to refuse treatment are covered by the Mental Health Act 2005, and as such, a doctor who administers treatment against your will under this provision is breaking the law.

How to refuse life-saving treatment

In order to refuse life-saving treatment, it is necessary to fulfil the following criteria:

  • Make a written statement – Lawpack’s solciitor-approved advance decision form can help
  • Ensure you sign and date the form
  • Make it clear you wish to refuse treatment even though you know it could save your life

When an advance decision may be overruled

In certain instances, a doctor might overrule an advance decision but this is only lawful under such conditions as the following:

  • You have contradicted your requests, perhaps through an official change in values such as switching religion
  • Unforeseen circumstances, such as the development of a new treatment, which could have affected your decision
  • Your written requests were too vague for doctors to determine your wishes in such a situation

Other instances that a decision cannot be used for include:

  • Refusal of treatment at a time when you are mentally or physically able to make that decision
  • Refusal of the administration of food and water through the mouth
  • To refuse practices in place solely to aid your comfort, such as the use of painkillers
  • To refuse basic nursing services, such as washing and mouth care
  • To request treatment that a healthcare professional deems inappropriate
  • Refusal of treatment for mental disorders at a point when you are subject to detainment under the Mental Health Act 1983

Advance decisions cannot be used to make requests about conditions not related to medical issues, such as financial matters.

The most comprehensive of advance decisions are well-written and detailed. To make one easily, please see Lawpack’s solciitor-approved advance decision form.

External information:


Published on: September 20, 2011