# Advance decisions to refuse treatment (ADRT) — the UK living will explained > Family & care · Last updated 26 May 2026 Canonical HTML: https://moneyguide.org.uk/family-life/advance-decisions-living-wills-uk/ Markdown mirror: https://moneyguide.org.uk/family-life/advance-decisions-living-wills-uk.md ## Quick answer An advance decision to refuse treatment, often called a living will, lets you refuse specific medical treatments in advance — in case you later lose the capacity to decide. An advance decision to refuse treatment, often called a living will, lets you refuse specific medical treatments in advance — in case you later lose the capacity to decide. Under the Mental Capacity Act 2005 it is legally binding on clinicians in England and Wales, but only if it meets strict formality rules. ## Key facts - Governed by ss24–26 Mental Capacity Act 2005 in England and Wales. Scotland has no direct equivalent; advance directives there carry strong persuasive weight but are not statutorily binding. - Refusing life-sustaining treatment (such as CPR or ventilation) requires the ADRT to be in writing, signed and witnessed, with an explicit statement that the refusal applies 'even if life is at risk'. - An ADRT can only refuse treatment. It cannot demand specific treatment, refuse basic care (warmth, hygiene, oral food and water) or override the Mental Health Act for compulsory treatment of a mental disorder. - A later Lasting Power of Attorney for Health & Welfare that gives the attorney power over life-sustaining treatment overrides an earlier ADRT on the same issue. ## What an advance decision can and cannot do An ADRT lets you say, in advance, that you do not want specified treatments in specified circumstances — for example refusing CPR after a major stroke, or refusing antibiotics in the final stage of dementia. The refusal is binding on clinicians once it is shown to be valid and applicable. It cannot be used to demand treatment a clinician does not consider in your best interests, to refuse basic care, or to ask for assisted dying — which remains unlawful in England, Wales and Northern Ireland. If the ADRT does not clearly apply to the actual situation, clinicians fall back on a best-interests decision under s4 Mental Capacity Act, consulting family and any registered Health & Welfare attorney. ## Formalities — when extra steps apply A general ADRT (refusing, say, a blood transfusion in non-life-threatening surgery) can be verbal, although writing is strongly recommended for evidence. An ADRT covering life-sustaining treatment must be in writing, signed by you (or someone in your presence at your direction), witnessed by one adult, and contain the words 'even if my life is at risk' or equivalent. Failing any of these makes that part unenforceable. Review the ADRT regularly — at least every few years and after any major change in health. An old document that does not match the current situation may be set aside. ## ADRT vs Lasting Power of Attorney An ADRT is your own decision recorded in advance. A Health & Welfare LPA delegates the decision to a trusted attorney. Both are valuable; they are not alternatives. Order matters. An ADRT made before an LPA that gives the attorney power over the same life-sustaining treatment is overridden by the LPA. If you want the ADRT to prevail, make it after registering the LPA and reference it expressly. Tell your GP, share copies with family and your attorney, and consider the NHS national record (Summary Care Record) so emergency clinicians can find it. ## Frequently asked questions ### Is a 'do not resuscitate' (DNACPR) form the same as an ADRT? No. A DNACPR is a clinical decision recorded by a doctor; it is not a legal instrument made by you. An ADRT is your binding refusal of CPR (or other treatment) and overrides a contrary clinical view, provided it is valid and applicable. ### Does an ADRT need to be registered? No. Unlike an LPA, there is no central register. Validity depends on you keeping the document accessible and telling clinicians it exists. The NHS Summary Care Record is the most practical way to make it visible in an emergency. ### Can I change my mind? Yes. You can withdraw or change an ADRT at any time while you have capacity. Withdrawal can be in any form — verbal, in writing or by destroying the document. Tell anyone who holds a copy so an outdated version is not relied on. ## Primary source https://www.nhs.uk/conditions/end-of-life-care/advance-decision-to-refuse-treatment/ ## Related - [Lasting power of attorney](https://moneyguide.org.uk/family-life/lasting-power-of-attorney/) - [How to make an advance decision (UK)](https://moneyguide.org.uk/how-to/make-an-advance-decision-uk/) --- Independent UK money guidance from [Money Guide](https://moneyguide.org.uk). Information only — not regulated financial advice.