Advance Care Directive - Makin...

Advance Care Directive - Making a Living Will

An Advance Care Directive is a way to record your wishes about future medical treatment and care.

In England and Wales, the legally binding part is usually called an Advance Decision to Refuse Treatment. It lets you refuse specific medical treatments in advance, in case you later lose mental capacity and cannot make or communicate the decision yourself.

Many people also use the term living Will, especially when talking about future treatment wishes and end-of-life care.

Creating an Advance Decision is free with By The Willow. We believe everyone should be able to record important treatment wishes without cost being a barrier.

At a Glance

◆ What it is: A document that records future treatment refusals and care wishes

◆ Who it is for: Adults who want more control over future healthcare decisions

◆ When it applies: If you lack capacity to decide or communicate at the time

◆ Why it matters: It helps doctors and loved ones understand what you would refuse

What Is an Advance Care Directive?

An Advance Care Directive can include preferences about future care, medical treatment, and the values that should guide decisions if you cannot speak for yourself.

It may cover:

◆ Treatments you would refuse in certain circumstances

◆ Life-sustaining treatment, such as CPR or ventilation

◆ Your values, beliefs, and priorities

◆ Where you would prefer to be cared for, where possible

◆ Who should know about your wishes

In England and Wales, if the document specifically refuses treatment, it is usually treated as an Advance Decision to Refuse Treatment.

In Scotland, similar wishes may be recorded in an advance statement or advance directive, but the legal framework is different.

Who Can Make a Living Will?

In England and Wales, you can make an Advance Decision if you are 18 or over and have mental capacity when you make it.

You must make it voluntarily, without pressure from anyone else.

Mental capacity means you can understand, retain, use or weigh the relevant information and communicate your decision.

How to Make a Living Will

There is no single government form you must use, but the document needs to be clear.

Useful steps include:

◆ Think about the treatments you would refuse and when

◆ Discuss your wishes with your GP or care team if helpful

◆ Write the refusal clearly and specifically

◆ Sign and date the document

◆ Use a witness if refusing life-sustaining treatment

◆ Share copies with your GP, relatives, and anyone involved in your care

How to Make Sure It Is Legally Effective

For an Advance Decision to be legally binding in England and Wales, it must be valid and applicable.

This means it should:

◆ Be made by someone aged 18 or over with mental capacity

◆ Clearly identify the treatment being refused

◆ Clearly explain the circumstances where the refusal applies

◆ Be made freely, without pressure

◆ Not be contradicted by later actions or a later Health and Welfare LPA

If it refuses life-sustaining treatment, it must also be in writing, signed, witnessed, and include a clear statement that it applies even if life is at risk.

Why Make an Advance Care Directive?

Making your wishes clear can help:

◆ Give you more control over future treatment decisions

◆ Make your wishes clearer for doctors and care teams

◆ Reduce pressure on relatives during stressful decisions

◆ Avoid treatment you would not want in specific circumstances

◆ Support more personal and compassionate end-of-life care

Keep your wishes up to date For £10 per year, you can update your Advance Decision whenever your health, wishes, relationships, or circumstances change. Update my document

Advance Decision and Lasting Power of Attorney

An Advance Decision is different from a Lasting Power of Attorney.

A Health and Welfare Lasting Power of Attorney lets you appoint attorneys to make certain health and care decisions for you if you lose capacity.

A Property and Financial Affairs Lasting Power of Attorney deals with money, property, and financial decisions.

If you have both an Advance Decision and a Health and Welfare LPA, the timing and wording matter. A later LPA may affect an earlier Advance Decision if it gives attorneys authority over the same treatment decisions.

Can an Advance Decision Be Challenged?

An Advance Decision may be questioned if there is doubt about whether it is valid or applicable.

This might happen if:

◆ There are concerns about capacity when it was made

◆ The wording is unclear or too broad

◆ The treatment or circumstances do not match what is written

◆ You later acted in a way that suggests you changed your mind

◆ A later LPA gives someone authority over the same treatment decisions

If someone is detained under mental health legislation, different rules may apply to treatment for mental disorder.

What If You Do Not Have a Living Will?

If you have not recorded your wishes, doctors and care teams may need to make decisions based on your best interests, clinical judgement, and information from those close to you.

Your family may be asked what they know about your wishes, but they may not know what you would have wanted.

Writing your wishes down can reduce uncertainty and make difficult moments easier for the people around you.

Where Should You Store It?

An Advance Decision is only useful if it can be found when needed.

You may want to give copies to:

◆ Your GP surgery

◆ Close relatives or friends

◆ Your attorneys, if you have a Health and Welfare LPA

◆ Your local hospital or care team

Ask your GP surgery to add it to your medical record and check that it has been recorded.

Reviewing and Updating Your Advance Decision

Your Advance Decision should reflect the person you are today. If your health, beliefs, relationships, or treatment wishes change, it is important that your document can change with you.

With By The Willow's unlimited updates option, you can keep your Advance Decision current for £10 per year. This gives you the flexibility to return to your document, update your choices, and make sure your wishes still feel right.

After making an update, print the new version, sign and witness it properly, and replace old copies wherever possible so doctors, relatives, and care teams are working from your latest wishes.

Summary

◆ A living Will can record treatments you would refuse in the future

◆ In England and Wales, this is legally known as an Advance Decision to Refuse Treatment

◆ It only applies if you lack capacity to decide or communicate at the time

◆ Life-sustaining treatment refusals must meet extra signing and wording rules

◆ Sharing and reviewing the document helps make sure it can be followed

Create your Advance Decision for free Record the treatments you would refuse in future and make your wishes easier for others to understand. Let's get started