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Free Advance Decision Template
An advance decision (sometimes called a living will) lets you set out which medical treatments you refuse in the future, should you lose the capacity to make or communicate those decisions yourself. Use our template to create a clear, legally compliant document in minutes.
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ADVANCE DECISION TO REFUSE TREATMENT
Mental Capacity Act 2005 Ss.24–26 · England And Wales · Living Will (ADRT)
DECLARANT DETAILS
| FULL NAME | Patricia Anne Harrison |
| DATE OF BIRTH | 18 July 1950 |
| ADDRESS | 28 Birchwood Close, Oxford OX1 3BT |
| TELEPHONE | 01865 123456 |
| NHS NUMBER | 485 777 3456 |
| DATE OF THIS ADRT | 1 March 2026 |
| PLACE OF SIGNING | Oxford |
HEALTHCARE CONTACTS
| GENERAL PRACTITIONER | Dr Claire Booth |
| GP SURGERY | Riverview Surgery, 10 High Street, Oxford OX1 1AA |
| GP TELEPHONE | 01865 224455 |
| EMERGENCY CONTACT / NEXT OF KIN | James Harrison (son) — 07700 900123 |
| COPIES OF THIS ADRT HELD BY | GP surgery, John Radcliffe Hospital records, son James Harrison, nephew Peter Harrison |
Date: 1 March 2026
Treatments refused: 4 selected
I, Patricia Anne Harrison, born on 18 July 1950, of 28 Birchwood Close, Oxford OX1 3BT, make this Advance Decision to Refuse Treatment on 1 March 2026 at Oxford. I am aged 18 or over, I have the mental capacity to make this decision within the meaning of sections 2 and 3 of the Mental Capacity Act 2005, and I fully understand the nature, purpose and likely consequences of the refusals set out below. I make this decision freely, voluntarily and without duress.
1.
STATUTORY BASIS
This Advance Decision is made under sections 24 to 26 of the Mental Capacity Act 2005. It is intended to be a valid and applicable advance decision within the meaning of section 25, such that, under section 26, it has the same effect as if I had made the decision contemporaneously and with capacity. I have regard to the guidance in Chapter 9 of the MCA 2005 Code of Practice and to the principles established in Airedale NHS Trust v Bland [1993] AC 789, Re T (Adult: Refusal of Treatment) [1993] Fam 95, Re B (Adult: Refusal of Medical Treatment) [2002] EWHC 429 (Fam) and Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67.
2.
CAPACITY AT THE TIME OF MAKING
I confirm that at the date of this Advance Decision I have the mental capacity to make it. I understand the information relevant to this decision, I am able to retain, use and weigh that information, and I am able to communicate my decision. I understand that I may withdraw or alter this Advance Decision at any time while I continue to have capacity, and that any such withdrawal or alteration shall be effective when made, orally or in writing (MCA 2005 s.24(3)–(5)).
3.
LASTING POWER OF ATTORNEY
I have granted a Lasting Power of Attorney for Health and Welfare to James Harrison, registered with the Office of the Public Guardian. This Advance Decision is made after the registration of that LPA. The attorney must act in accordance with the principles and provisions of the Mental Capacity Act 2005 and must give effect to any valid and applicable advance decision made by me (MCA 2005 s.11(7)(b)).
4.
TREATMENTS I REFUSE
I refuse the following specified medical treatments in the circumstances set out in the following clause:
1. Cardiopulmonary Resuscitation (CPR) — chest compressions, defibrillation and associated interventions
2. Mechanical ventilation (invasive or non-invasive) where required to sustain life
3. Clinically-assisted (artificial) nutrition and hydration, whether by nasogastric tube, PEG/RIG or intravenous route
4. Admission to an Intensive Care Unit (ICU) or High Dependency Unit for invasive organ support
1. Cardiopulmonary Resuscitation (CPR) — chest compressions, defibrillation and associated interventions
2. Mechanical ventilation (invasive or non-invasive) where required to sustain life
3. Clinically-assisted (artificial) nutrition and hydration, whether by nasogastric tube, PEG/RIG or intravenous route
4. Admission to an Intensive Care Unit (ICU) or High Dependency Unit for invasive organ support
5.
CIRCUMSTANCES IN WHICH REFUSALS APPLY
These refusals apply in the following specified circumstances, and not otherwise:
I have been diagnosed with advanced dementia or an equivalent neuro-degenerative condition, I no longer recognise my close family, I am no longer able to feed myself, and I lack the mental capacity to make or communicate treatment decisions.
If the circumstances that actually arise are materially different from those specified, or if there are reasonable grounds for believing that circumstances exist that I did not anticipate and which would have affected my decision had I anticipated them, this Advance Decision shall not be applicable (Mental Capacity Act 2005 s.25(4)(c)).
I have been diagnosed with advanced dementia or an equivalent neuro-degenerative condition, I no longer recognise my close family, I am no longer able to feed myself, and I lack the mental capacity to make or communicate treatment decisions.
If the circumstances that actually arise are materially different from those specified, or if there are reasonable grounds for believing that circumstances exist that I did not anticipate and which would have affected my decision had I anticipated them, this Advance Decision shall not be applicable (Mental Capacity Act 2005 s.25(4)(c)).
6.
STATEMENT APPLICABLE TO LIFE-SUSTAINING TREATMENT
I expressly confirm — as required by section 25(5) of the Mental Capacity Act 2005 — that where the treatments refused above are life-sustaining, this Advance Decision is to apply to that treatment even if my life is at risk. I understand that without this express statement, any refusal of life-sustaining treatment in this document would be invalid.
7.
COMFORT CARE AND PALLIATIVE TREATMENT (NOT REFUSED)
I wish to continue to receive pain relief, palliative sedation and all comfort measures necessary to ease my suffering. I wish to be kept clean, warm and comfortable, with mouth care and pressure-area care, and where possible to be nursed in my own home.
8.
RELIGIOUS, SPIRITUAL OR CULTURAL WISHES
I wish a Church of England minister to be called if death is expected, and for the Lord's Prayer to be said at my bedside.
9.
ORGAN AND TISSUE DONATION
My wishes in relation to organ and tissue donation are recorded on the NHS Organ Donor Register and/or the Organ Donation (Deemed Consent) Act 2019 applies.
10.
NO REQUEST FOR ASSISTED DYING
Nothing in this Advance Decision requests, encourages or assists any person to end my life. I acknowledge that section 2 of the Suicide Act 1961 (as amended) makes it a criminal offence to do any act capable of encouraging or assisting the suicide of another. The refusals in this Advance Decision are lawful refusals of medical treatment, not requests for assisted dying.
11.
HUMAN RIGHTS AND CLINICAL BEST INTERESTS
I have considered the competing interests protected by Articles 2 (right to life) and 8 (right to respect for private life) of the European Convention on Human Rights as given effect in UK law by the Human Rights Act 1998. I intend this Advance Decision to stand as an exercise of my autonomy which, once valid and applicable, displaces any best-interests analysis under section 4 of the Mental Capacity Act 2005 in relation to the specified refusals, as confirmed in Aintree University Hospitals NHS Foundation Trust v James [2013] UKSC 67.
12.
LEGAL EFFECT AND PROTECTION OF CLINICIANS
Where this Advance Decision is valid and applicable to treatment proposed by a clinician, the clinician must not provide that treatment (MCA 2005 s.26(1)). A clinician who withholds or withdraws treatment in reasonable reliance on this Advance Decision does not incur liability for so doing (s.26(3)). A clinician who provides treatment in circumstances where they did not know of, or reasonably believed this ADRT not to be applicable to, the treatment, likewise does not incur liability (s.26(2)). Any dispute about the validity or applicability of this Advance Decision should be referred to the Court of Protection (s.26(4)).
13.
NOTIFICATION AND COPIES
A copy of this Advance Decision should be provided to:
(a) my General Practitioner, for inclusion in my primary-care record;
(b) any hospital or specialist clinician responsible for my ongoing care;
(c) my nominated emergency contact / next of kin; and
(d) any attorney under a registered Lasting Power of Attorney for Health and Welfare.
I should keep the original signed document in a location known to these persons. It is recommended to note the existence of this ADRT in the Summary Care Record / Electronic Palliative Care Coordination System (EPaCCS) where available.
(a) my General Practitioner, for inclusion in my primary-care record;
(b) any hospital or specialist clinician responsible for my ongoing care;
(c) my nominated emergency contact / next of kin; and
(d) any attorney under a registered Lasting Power of Attorney for Health and Welfare.
I should keep the original signed document in a location known to these persons. It is recommended to note the existence of this ADRT in the Summary Care Record / Electronic Palliative Care Coordination System (EPaCCS) where available.
14.
WITHDRAWAL AND REVIEW
I understand that I may withdraw or alter this Advance Decision at any time while I have capacity to do so. Withdrawal need not be in writing (MCA 2005 s.24(3)–(4)). I intend to review this Advance Decision periodically and to re-sign it or update it if my circumstances or wishes change. An Advance Decision is not invalidated by the mere passage of time but a clinician may have regard to its age when considering applicability.
15.
CONFIRMATION
I confirm that this Advance Decision to Refuse Treatment represents my genuine, considered and settled wishes. I have made it freely, having had the opportunity to consider it, and, where appropriate, having discussed it with my GP, healthcare professionals, or trusted family members. I intend it to apply even if my life is at risk as a result of refusing the treatments listed above, to the extent confirmed by the life-risk statement in clause 6.
16.
WITNESS ATTESTATION (MCA 2005 S.25(6))
The witness named below confirms that they were present when the Declarant signed this Advance Decision; that the Declarant appeared to the witness to have the mental capacity to make it; and that the witness is independent of the Declarant (not a relative, partner or beneficiary of the Declarant's estate).
Witness's own statement of independence: I am not a relative, partner or beneficiary of the Declarant.
Witness's own statement of independence: I am not a relative, partner or beneficiary of the Declarant.
WITNESS PARTICULARS
| WITNESS — ADDRESS | Riverside Surgery, 15 High Street, Oxford OX1 1AB |
| WITNESS — OCCUPATION | General Practitioner (MRCGP) |
DECLARANT — SIGNED IN PRESENCE OF WITNESS (MCA 2005 S.25(6))
Patricia Anne Harrison
Date: ____________________
WITNESS — SIGNED IN PRESENCE OF DECLARANT
Dr Anita Patel
General Practitioner (MRCGP)
Date: ____________________
Available as a print-ready PDF or an editable Microsoft Word (.docx) file.
What Is an Advance Decision?
An advance decision is a legally binding document that allows an adult with mental capacity to refuse specific medical treatments in advance. Under the Mental Capacity Act 2005, healthcare professionals in England and Wales must follow a valid and applicable advance decision, even if they believe the treatment would benefit the patient.
Advance decisions only cover treatment refusals — they cannot be used to demand particular treatments. They come into effect only when the person has lost the capacity to consent to or refuse the treatment in question.
If you wish to refuse life-sustaining treatment, the UK advance decision must be in writing, signed, witnessed, and contain a clear statement that the decision applies even if your life is at risk. Without these formalities under British law, the refusal of life-sustaining treatment will not be legally binding in England and Wales.
What's Covered in This Template
Our advance decision template covers all the elements required for validity under English law:
Personal Details
Full name, date of birth, and address to clearly identify the decision-maker.
Statement of Capacity
Confirmation that you have mental capacity at the time of signing.
Treatments Refused
Specific medical treatments you wish to refuse, described clearly.
Circumstances
The conditions or situations in which each refusal applies.
Life-Sustaining Treatment Clause
Express statement that the refusal applies even if life is at risk, where relevant.
Signature & Date
Your dated signature as required by the Mental Capacity Act 2005.
Witness Signature
A witness signature, required when life-sustaining treatment is refused.
GP or Solicitor Details
Optional section to record who holds a copy of the document.
Review Date
A reminder date to review and update the decision periodically.
Revocation Clause
Explanation of how the advance decision can be withdrawn or changed at any time while you have capacity.
How to Create an Advance Decision
Follow these steps to produce a valid advance decision under English law:
- 1
List the Treatments You Refuse
Be as specific as possible — name particular treatments, procedures, or interventions rather than using vague language.
- 2
Describe the Circumstances
State the conditions under which each refusal applies, for example a particular diagnosis or stage of illness.
- 3
Include a Life-Sustaining Treatment Statement
If any refusal covers life-sustaining treatment, add a clear written statement confirming the decision applies even if your life is at risk.
- 4
Sign and Have It Witnessed
Sign and date the document. If life-sustaining treatment is refused, a witness must also sign in your presence.
- 5
Share and Store Safely
Give copies to your GP, close family members, and any appointed attorneys. Keep the original in a safe but accessible place.
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Legal Considerations
Advance decisions in England and Wales are governed primarily by the Mental Capacity Act 2005 and its accompanying Code of Practice.
This template is for informational purposes only and does not constitute legal advice. Consult a qualified solicitor for advice specific to your situation.
Reviewed for England & Wales law
Mental Capacity Act 2005
Sections 24–26 of the UK Mental Capacity Act 2005 set out the rules for making, validating, and applying advance decisions in England and Wales. A decision is valid if made by a British person aged 18 or over who had capacity at the time, and has not been withdrawn or overridden by a later lasting power of attorney for health and welfare.
Life-Sustaining Treatment Requirements
A UK advance decision that refuses life-sustaining treatment is not valid unless it is in writing, signed by the maker (or by another person in the maker's presence and at their direction), witnessed, and includes an express statement that the decision stands even if life is at risk under English law.
Interaction with LPAs
If you later create a UK lasting power of attorney (LPA) for health and welfare that gives the attorney authority over the same treatment decisions, the British LPA will override the advance decision. It is important to review both documents together under English law.
Review and Revocation
A UK advance decision can be withdrawn at any time while you have capacity, either orally or in writing. It is good British practice to review the document regularly, especially after any change in your health, circumstances, or wishes in England and Wales.
Frequently Asked Questions
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