This guide is maintained as a current resource for September 2026 and covers only the laws of England and Wales. Information is for general guidance, not legal advice. Consult a qualified solicitor for advice specific to your situation.
A living will (advance decision to refuse treatment) in England and Wales lets you refuse specific medical treatments ahead of time if you lose capacity. This guide explains legal requirements, what it can and cannot do, how to make one, and how it works in practice under the Mental Capacity Act 2005.
A living will is a legal tool that enables you to express your preferences about medical treatment in advance of a time when you may no longer be able to make or communicate decisions for yourself. Although the phrase living will is widely used by the public, in the legal framework of England and Wales this concept is formally known as an advance decision to refuse treatment under the Mental Capacity Act 2005. This article explains what a living will is, how it works, what legal requirements apply, and how it fits into planning for future healthcare decisions. The aim is to provide accurate, accessible information for members of the public, students, and solicitors alike.
Understanding Advance Decisions
A living will allows an adult with mental capacity to set out specific decisions about what treatments they would refuse in the future if they lose the ability to decide at the relevant time. These advance decisions come into effect only if, later on, you lack the capacity to make or communicate decisions about treatment at that moment. In that scenario, healthcare professionals must follow a valid and applicable advance decision, even if doing so may hasten or result in death.
Living wills do not give authority to demand treatment, choose treatments you do want, or instruct others to make decisions on your behalf – those tools (such as Lasting Powers of Attorney) are separate and governed by different legal rules.
Advance Decision vs Advance Statement
It is important to differentiate a living will (advance decision) from an advance statement:
- Advance Decision (living will): Legally binding if valid and applicable. It allows you to refuse specified medical treatments in future scenarios when you lack capacity.
- Advance Statement: Not legally binding. It records your preferences, values, or wishes about care and treatment without refusing specific procedures. Healthcare professionals should take such statements into account, but they are not legally enforceable.
Legal Foundation: Mental Capacity Act 2005
The legal basis for living wills in England and Wales is the Mental Capacity Act 2005. This Act sets out when and how people can make decisions in advance, and defines the concept of mental capacity - the ability to understand, retain and weigh relevant information to make a decision, and to communicate that decision.
Under the Act:
- You can refuse any medical treatment you do not want to receive in future with an advance decision.
- This refusal applies even if the treatment could prolong life.
- You cannot use a living will to request treatment or direct others to act in a particular way.
- Assisted suicide or euthanasia remain unlawful in the UK.
What Can You Refuse?
A living will is typically used to refuse particular types of medical treatment that you would not want in certain future circumstances. Common examples include:
- Cardiopulmonary resuscitation (CPR): Refusal of efforts to restart breathing or heartbeat if these stop unexpectedly.
- Life‑sustaining treatment: Such as ventilation, artificial feeding or hydration.
- Specific interventions: Blood transfusions, antibiotics, or other procedures you do not want if you cannot communicate later.
When refusing life‑sustaining treatment, the document must be written, signed and witnessed, and include a clear statement that the refusal applies even if life is at risk as a result.
What a Living Will Cannot Do
A living will cannot:
- Order the provision of specific treatments.
- Appoint someone to make decisions for you (this is done via Lasting Power of Attorney for health and welfare).
- Demand illegal medical actions (for example, euthanasia or assisted suicide).
- Refuse basic nursing care such as comfort measures, food or drink by mouth, or pain relief.
Making a Living Will
Eligibility
To make a legally effective living will (advance decision), you must:
- Be 18 years old or over.
- Have the mental capacity to make the decision at the time you create it.
- Clearly specify which treatments you would refuse and in what circumstances. For life‑sustaining treatment, signed and witnessed documentation is essential.
Clarity and Applicability
An advance decision is only used if it is valid and applicable to the circumstances at the time a treatment decision is required. Specific and unambiguous wording reduces the risk of uncertainty in clinical settings. Healthcare professionals will only apply the advance decision if it clearly applies to the situation and indicates refusal of the treatment in question.
Withdrawal or Amendment
You may amend or withdraw an advance decision at any time while you retain mental capacity. Withdrawal may be express (by stating your change of mind) or implied (by acting in a way that contradicts the document). Once you lack capacity, you cannot change the advance decision, and it will continue to apply if valid and relevant.
How Living Wills Are Used in Practice
A living will comes into play only if you lose mental capacity at the time when a treatment decision is needed. If you remain able to consent or refuse treatment at that moment, your current wishes take precedence over any advance decision. Healthcare professionals are required by law to follow a valid and applicable advance decision, even if they disagree with its content, provided it meets the criteria of the Mental Capacity Act.
Practically, most people share copies of their living will with family members, carers, and their GP or relevant medical team, and include it in their medical records where possible to ensure it is easily accessible when needed.
Common Questions and Considerations
Is a Living Will Legally Binding?
Yes - but only if it meets the legal criteria (validity and applicability) under the Mental Capacity Act 2005. If it does not meet these requirements, healthcare professionals may disregard it in favour of acting in your best interests at the time.
Do I Need a Solicitor?
No formal legal requirement exists to use a solicitor to draft a living will, but legal or clinical advice can help ensure clarity and reduce ambiguity. Templates are available from reputable sources, including NHS and charitable organisations specialising in advance care planning.
Does It Override Family Wishes?
In England and Wales, a valid advance decision legally binds healthcare professionals. Family members or carers cannot legally override it, though they can discuss concerns with clinicians.
Key Takeaways
A living will in England and Wales, legally known as an advance decision to refuse treatment, enables you to refuse specific medical treatments in advance of a time when you might lack the capacity to make or communicate these decisions. Governed by the Mental Capacity Act 2005, it is legally binding if valid and applicable. The framework supports personal autonomy in healthcare planning but does not allow demands for treatment, appointment of decision‑makers, or requests for unlawful actions. Clear, specific wording and proper execution are key to ensuring the advance decision works effectively when needed.
