An advance statement is a form that lets you record the care you want in the future. It can cover any aspect of your care including:
- where you want to be cared for, for example at home or in a hospice
- your daily routine, for example when you like to get up and eat your meals
- your religious beliefs and how these affect your care
- anything you do not want to happen to you
It is not the same as a living will (advance decision) which is only used to refuse specific medical treatments.
An advance statement will only be used to guide decisions if you lack mental capacity to make or communicate a decision for yourself.
What is mental capacity?
Mental capacity is the ability to make a decision for yourself.
While you have mental capacity you have the right to make decisions about your medical treatment and care. You can choose to refuse or consent to treatment. Your advance statement can only be used if you do not have mental capacity to make or communicate a decision for yourself.
The law in England and Wales says that someone’s mental capacity should be assumed, unless there is reason to question it. For example, if they have had a brain injury or a diagnosis of dementia.
You must be able to do all four of these things to have mental capacity to make a decision:
- Understand the information
- Retain the information long enough to make a decision
- Weigh up the information against other factors
- Communicate the decision once you have made it
Mental capacity is decision specific. This means that someone may have the mental capacity to make some decisions but not others. For example, someone with advanced dementia may have the mental capacity to decide what they want to eat that day, but not to make a decision about refusing CPR.
In Scotland and Northern Ireland the principle of mental capacity is similar, but they have their own definitions. The Office of the Public Guardian in Scotland has a helpful definition of incapacity on their website. The Department of Health NI define mental capacity in their Code of Practice (PDF, 2.8MB).
An advance statement is not legally binding. This means that the people caring for you do not have to follow the exact instructions in it, but they must use it as a guide when making decisions on your behalf.
Why you should make an advance statement
Making an advance statement is a good way to start thinking about what is important to you and your quality of life. It can help you to make decisions about what care and treatment you do and do not want in the future.
Many people will lose mental capacity at some point towards the end of life. For example, some people with advanced dementia can live for several years needing care and support from others. In situations like this, an advance statement can be a very useful document for your relatives, nurses and doctors as it lets them know how you want to be cared for if you lack mental capacity.
If you want to talk to a friend or relative about planning for their future care, an advance statement can be a good place to start. You can use our advance statement template (PDF, 118KB) to guide your conversation about what is important to them now and in the future.
What if you’ve made a living will (advance decision)?
An advance statement can include any information that is important about your health or care. This is different from a living will which is only used to refuse specific medical treatments.
If you’ve made a living will then it’s a good idea to also make an advance statement as it can help the people caring for you to have a better understanding of your wishes for care. If you’re in a situation that is not included in your living will, an advance statement will help them to make decisions in your best interests.
What if you’ve made a health power of attorney?
A health power of attorney is a legal document that lets you give someone you trust the power to make decisions for you. They can make any decisions about your treatment and care. For example, where you live, your daily routine and the people you see and spend time with.
If you have made a health power of attorney then it’s a good idea to also make an advance statement to guide your attorney when making these decisions on your behalf.
Do you have a long-term condition or a new diagnosis?
Many people make an advance statement while they are well and want to make sure their relatives and doctors know what they do and do not want to happen to them in the future. Some people are prompted to record their wishes because they are living with a long-term condition, or have had a new diagnosis.
If you are living with a long-term condition or have a new diagnosis, we can help. Our peer navigator service can help you come to terms with a diagnosis, speak to relatives and doctors, and plan next steps.
Our peer navigator service can help you to:
- come to terms with a new diagnosis and plan next steps
- make decisions about complex treatment options
- speak to your doctor and ask the right questions
- access local and national services for support
- understand and make sense of your new situation
If you are living with a long-term condition or have a new diagnosis, we can help.
Call 0800 999 2434 or email us.
What you can include in your advance statement
In your advance statement you can include anything that is important to you and your quality of life, and how these things affect decisions about your care.
You can include:
- how you like spending your time
- important information about your identity
- your values, religious or spiritual beliefs
- important people in your life
- your lifestyle and habits
- your food preferences and allergies
- where you want to live and be cared for at the end of life
- information about your health
You should not use your advance statement to refuse medical treatments because it is not legally binding. To refuse medical treatments in advance you should make a living will (advance decision).
Example statements you can include:
- I want to be cared for at home
- I am a strict vegetarian
- I enjoy gardening and spending time outside
- I like listening to Smooth FM radio
- I do not like animals or having them in my space
What if you don’t want to be taken to hospital?
If you do not want to be taken to hospital for treatment you can write this in your advance statement. You should also record the treatments you want to refuse in a living will.
You will need to have a conversation with your GP or care team to understand what will happen if you become unwell, and to put a plan in place so you can be cared for outside of hospital. This care plan will depend on your personal needs and the support available. They can also talk to you about options that may be available to you, including moving to a hospice or nursing home at some point in the future if you need more support.
If you have a clear care plan this will help to make sure you are not taken to hospital in an emergency if you do not want this and if it can be avoided. However, in some situations it may be necessary to take you to hospital.
If you are still worried about being taken to hospital you can talk to us:
- by phone on 0800 999 2434
- by email at firstname.lastname@example.org
Make an advance statement
Anyone over the age of 18 with mental capacity can make an advance statement. We have a helpful advance statement template which can guide you through what you might want to include.
To make one you need to:
- Fill in the form
- Share copies with your GP and relatives
- Review it regularly
Make an advance statement online
Create an account to start your advance statement online. Using our online form you can:
- Save your form and complete it later
- Review your answers and fix any mistakes
- Print multiple copies to share
Sign in to your account
Sign into your account to access a form you’ve already started or finished.
Use the paper form
Download our advance statement template (PDF, 120KB) and print it, then complete it by hand. If you do not have a printer you can call us on 0800 999 2434 and we’ll post the form to you.
We can help you complete your form
If you would like to talk it through or need help with the wording you can contact us by:
- phone on 0800 999 2434
- email at email@example.com
Sharing your advance statement
Once you have completed your advance statement you will need to share it widely so that it is known about and can be followed. The NHS will not have your form on file unless you share it with them and we do not keep copies on your behalf.
You should share a copy with your:
- close friends
- GP surgery
- anyone else involved in your care
You can make an appointment to discuss the form with your GP so that they understand your wishes. If you do not want to discuss it with your GP you should still make sure it is added to your medical record.
It is a good idea to keep a copy with your other important documents, for example your living will or health power of attorney.
Review and update your advance statement
If you have an advance statement you should review it regularly, we recommend every two years or sooner if your health or wishes change. It is important to do this to make sure your advance statement reflects your current wishes for care.
To review your advance statement, read through each section to check that the information is still correct and it includes everything you want. If you need to make a lot of changes it is a good idea to complete a new form so that your wishes are clear and easy to understand.
There are a few things you can do in advance to tell people what treatment and care you want in the future.
- Living will (advance decision) – used to refuse any medical treatments that you do not want to be given in the future
- DNR form – a form you can only get from your doctor which is used to prevent people being given CPR inappropriately
- Health power of attorney – a legal document used to give someone you trust the power to make decisions for you
Page last reviewed: 14 January 2022
Next review due: 14 June 2022