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Advance decision (or 'living will')

advance decisions

An advance decision (formally known as a 'living will' or 'advance directive') informs medical staff about how you wish to be treated should you no longer be able to communicate your wishes to your medical team.

What is an Advance Decision?

An Advance Decision allows whoever is responsible for your medical care to be informed about what treatment you may or may not want if you are no longer able to communicate your wishes or lack the mental capacity to make decisions.

Typical examples of this would be in cases of dementia or stroke, where you may not be able to communicate or consent to specific treatment. Doctors would decide what they consider to be in your best interests unless you have made an Advance Decision.

Is an Advance Decision legally binding?

An Advance Decision must be respected by medical professionals and is legally binding under the Mental Capacity Act 2005.

An Advance Statement can also be considered a Living Will but would refer more to your general treatment, eg, food preferences and religious beliefs rather than medical treatment.

Advance Statements can also be used to let the people treating you know who you would like to be consulted when a decision has to be made, if you are unable to make that decision yourself. An Advance Statement is not legally binding but should be taken into consideration.

When would an Advance Decision be used?

Examples of something you might state in an Advance Decision:

  • You may not want blood transfusions.
  • You may not want an amputation.
  • You may not want to be kept alive in a vegetative state.

The requirement for an Advance Decision in cases of HIV infection and illness is much less likely than it was several years ago as treatment has improved dramatically.

What happens to an Advance Decision if I appoint an attorney to make decisions for me?

If you are aged 18 or older and have mental capacity you can also appoint someone to be your attorney. They can make decisions about future treatment on your behalf if you lack the mental capacity to do so. They cannot override an Advance Decision you have made unless they were granted lasting power of attorney at a later date, and the document states that they have been given the power to do so.

If an Advance Decision is not made, and an attorney has not been appointed, it might be possible to apply to the Court of Protection to become a deputy if you care for someone that has lost mental capacity.

In the event that none of the above is in place, the Local Authority or the NHS will provide an Independent Mental Capacity Advocate (IMCA) to support and represent the individual.

How can I prepare an Advance Decision?

An Advance Decision can be written or verbal unless it deals with life-sustaining treatment, in which case it must be written and specific rules apply.

If the Advance Decision refuses life-sustaining treatment, it must:

  • be in writing
  • be signed and witnessed
  • state clearly that the decision applies even if life is at risk
  • include a written statement to say that the Advance Decision is to apply to the specific treatment even if your life is at risk.

You cannot make an Advance Decision refusing actions necessary to keep you comfortable such as warmth, shelter and hygiene.

How can I get more information?

You can get Advance Decision information from health and social care professionals (for example, your GP or social worker). It is not essential that you use a special form, but it may be helpful. You can read more about Advance Decisions and access forms to complete here:

You can also talk to our Online Adviser about legal issues surrounding living wills.

Over 50 and living with HIV?

The Health Wealth and Happiness Project supports the financial, emotional and physical wellbeing of over 50s living with HIV in Brighton, Bristol, London, Manchester and the West Midlands.



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The Information Standard: Certified member

This article was last reviewed on 25/9/2014 by C. Berry

Date due for the next review: 30/9/2017

Content Author: G. Arrindell

Current Owner: D. Anyanwu

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