Advance decision (living will) in 2026: how to refuse unwanted treatment in advance

An advance decision to refuse treatment (ADRT), commonly a "living will", is a decision you make now to refuse a specific type of treatment in the future if you cannot express it yourself. According to the NHS, if the conditions are met such a decision is legally binding on medical staff.

What does an advance decision let you do?

It records a refusal of specific interventions — for example mechanical ventilation or resuscitation — in situations you describe. It cannot demand a particular treatment and cannot ask to hasten death; it is purely a tool for refusal.

When is it legally binding?

According to the NHS, an advance decision is binding if it complies with the Mental Capacity Act, is valid, and applies to the situation that arises. If any one of these is not met, doctors will act in your best interests another way.

Who can make one?

According to the NHS, a decision is valid only if, when you made it, you were 18 or over and had the capacity to make, understand and communicate your decision. So you must make it while you can clearly express your wishes.

What are the form requirements?

To refuse life-sustaining treatment, strict rules apply: according to the NHS, the decision must be written down and signed by you and a witness, and it must state that it applies even if your life is at risk. For less critical decisions the form can be less formal.

How does it differ from an advance statement?

According to the NHS, they are not the same. An advance statement sets out your wishes about how you would like to be cared for (for example daily preferences and care), and does not carry the same legal force. An advance decision is a binding refusal of specific treatment.

It is worth discussing an advance decision with your doctor and family and storing it so medical staff can find it quickly. It is a difficult subject, but wishes expressed in advance spare your loved ones agonising decisions at a critical moment.