Living will (advance decision)

A living will is a form which lets you refuse any medical treatments that you do not want to be given in the future.

It will only be used 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 living will 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:

  1. Understand the information
  2. Retain the information long enough to make a decision
  3. Weigh up the information against other factors
  4. 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).

A living will is also known as an advance decision or advance directive, but the legal name is advance decision to refuse treatment.

Important: Important

Living wills are legally binding in England and Wales, and in Northern Ireland. They are not legally binding in Scotland but should be taken into account by doctors.

Regardless of where you live, it is always best to have your wishes clearly written down so your doctor knows about any treatments you do not want to be given.

Some people want to see our template living will form (PDF, 702KB) before they start so that they have a better idea of what is involved.

Why you should make a living will

You might lose mental capacity to make decisions because of an accident or illness. If this happens and a decision needs to be made about your treatment or care, a doctor will have the final say unless you have made a living will or a health power of attorney.

You should make a living will if there are situations you want to avoid or medical treatments you do not want. 

Some people make a living will because they:

  • do not want their life artificially prolonged
  • want to stay in control
  • have witnessed a friend or relative have a bad death
  • want to make things easier for their family
  • are getting older and want to be prepared
  • have been diagnosed with a serious illness
Information:

“I’m a very active person and I don’t want to be kept alive with lots of machines and tubes when the time comes. I want to die peacefully. Now that I’ve made my living will I know that I won’t be given lots of invasive treatments in hospital and I can have a dignified death.”

Margaret, 65

Most people make a living will while they are well. They 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.

What is our peer navigator service for?

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.

Does a doctor have to follow my living will?

A living will is legally binding in England, Wales and Northern Ireland if it meets certain criteria, known as valid and applicable. If valid and applicable, a living will has the same effect as a decision made by a person with mental capacity and doctors must follow it.

Living wills are not legally binding in Scotland but are often recognised and followed by doctors. Regardless of where you live, it is always best to have your wishes clearly written down so your doctor knows about any treatments you do not want to be given.

We know in some situations doctors can be unfamiliar with living wills. To help with this, you should speak to your doctor about your living will so that they understand your reasons for making one. It can also help to give a copy to a friend or relative, who can use your living will to speak up on your behalf if needed. 

If after speaking to your doctor you are worried that your living will may not be followed contact us by:

Our template living will meets the requirements needed for it to be valid. Using a well-tested template, like our form, is the best way to make sure your living will be followed.

What makes a living will valid?
  • It is made by an adult with mental capacity
  • It includes a sentence which says your decisions are to apply, even if your life is at risk
  • It clearly explains the treatments to be refused
  • It clearly explains the situations your refusal should apply in
  • It has been signed and witnessed
  • You have not been pressured to make the living will
  • You have not done anything that goes against what is written in the living will
What makes a living will applicable (when it will be used)?
  • You lack mental capacity to make the decision in question
  • It applies to the situation you are in
  • It applies to the treatment offered
  • There is no reason to believe you have changed your mind since making it

Make a living will

Anyone over the age of 18 with mental capacity can make a living will.

To make one you need to:

  1. Fill in the form (our template can help)
  2. Sign and date the form
  3. Get it witnessed (this can be anyone, including a relative)
  4. Share a copy (with your relatives, GP, local hospital and local ambulance trust)
  5. Review it regularly (every two years or sooner if your health or wishes change)

Some people complete their living will in one go, others take longer. Everyone is different and you should take as long as you need. 

Can I help a relative make a living will?

You cannot make a living will for someone else, but you can help them complete their form if they need support. If you do this all of the information, statements and decisions in it must be their own.

If someone has lost mental capacity it is too late for them to make a living will and you cannot make it on their behalf. If you are in this situation and need support call our information line on 0800 999 2434.

Make a living will online

You can make a living will online or you can use a paper form.

Create an account to start your living will 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

You will need to print the form and sign it when you’ve finished.

Use the paper form

Download our template form (PDF, 702KB) and print it, then complete it by hand. If you do not have a printer, call us on 0800 999 2434 and we’ll post you the form.

Sign in to your account

Sign in to your account to access a form you’ve already started or finished.

Using a solicitor

You do not need to use a solicitor to make a living will. They can charge around £200 and we have often seen forms made by solicitors that do not include the information needed to be legally valid. We specialise in supporting people to write living wills and we can help you make one for free.

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:

What you can include in your living will

You can use a living will to refuse any medical treatment, including anything intended to prolong or sustain your life (known as life-sustaining treatment).

Life-sustaining treatments can include:

  • cardiopulmonary resuscitation (CPR)
  • mechanical ventilation, both invasive (intubation) and non-invasive (CPAP)
  • clinically assisted nutrition and hydration
  • antibiotics (for life-threatening infections)

Some people want to refuse all life-sustaining treatment if they lose mental capacity, while others only want to refuse some life-sustaining treatments in certain situations. You can tailor the form to your individual wishes.

Using our template form

Our living will form covers the situations that people are most likely to lose mental capacity. You can choose to include a refusal of all life-sustaining treatment for:

  • dementia
  • brain injury, often caused by a head injury or a stroke
  • diseases of the central nervous system, for example motor neurone disease (MND), Parkinson’s disease, multiple sclerosis (MS) and Huntington’s disease
  • terminal illness

As well as the situations above, there is space on our form for you to write your own refusal of treatment if you feel the above situations do not cover exactly what you want. For example, some people have a condition or illness and know specific treatments that are likely to be offered for it, but they do not want.

We can help you complete your form

If you need any support writing your living will you can call our nurse on 0800 999 2434.

Sharing your living will

Once you have completed your living will 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:

  • relatives
  • close friends
  • GP surgery
  • local hospital
  • local ambulance trust

You should share a copy with relatives and close friends who may be called to the hospital if you are admitted in an emergency. This is especially important if you are admitted during the night or over the weekend as your GP surgery might be closed.

A GP does not need to sign your living will but you can make an appointment to discuss the form with them so that they understand your wishes. If you do not need to discuss it with your GP you should still make sure it is added to your medical record.

If you make an appointment, or just drop off your form at reception, it is worth following up with your GP surgery a few weeks later to check that your living will has been added to your GP medical record. We have heard of some situations where the form has been lost or not recorded correctly.

Unfortunately your GP medical record may not be available to all healthcare professionals so it can be a good idea to also share a copy with your local hospital and local ambulance trust.

In an emergency

A valid living will must be followed but in an emergency paramedics may not know about your living will straight away. Paramedics will often look in your bag for details of who you are, so carrying a folded copy of your living will in a clearly marked envelope when you go out can help to make sure it is found.

When you’re at home you should keep a copy in an obvious place. You can use the Lions Club Message in a Bottle scheme to keep a copy of your living will in the fridge. Paramedics should know to look for the Lions Club symbol when entering your house and to check the fridge.

Review and update your living will

If you have a living will 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 living will reflects your current wishes. Also, if a doctor knows that a living will is up to date they will be more confident that what you’ve written is still what you want.

To review your living will, read through each section to check that the information is still correct and the refusal of treatment covers everything you want it to.

If you have no changes

If you do not want to make any changes all you need to do is sign and date the form in the ‘review dates section’.

To change your personal details

If you only need to make changes to your personal details (for example your address, or you’ve changed your GP) then you can do this and initial and date next to the changes. You should then sign and date the form in the ‘review dates section’.

To change the refusal of treatment

If you want to make changes to your refusal of treatment then you will need to re-sign and date the form, and have this witnessed. If you are making a lot of changes then you may want to complete a new form, to make sure your refusal of treatment is clear.

Living will and health power of attorney

A living will is a form written by you to refuse medical treatments in advance. It only covers decisions to refuse specific medical treatments.

A health power of attorney lets you give someone you trust the power to make decisions for you if you cannot make decisions for yourself. The legal name is lasting power of attorney for health and welfare. It can cover decisions about medical treatment, as well as any decision about your care, for example where you live and your daily routine.

They are both legally binding and cannot be used unless you lose the mental capacity to make decisions for yourself.

Do I need a living will and a health power of attorney?

You do not need both, but having a living will and a health power of attorney can be a good idea because:

  • it can make things easier for the attorney as the living will gives a clear indication of what you want
  • a living will can help your attorney prove to doctors and care staff that they are acting in your best interests
  • a living will only refuses specific medical treatments, so if any other decisions need to be made, for example where you will be cared for, a doctor will decide unless you have appointed a health power of attorney
  • if your situation changes, for example if your attorney dies, then you will still have your living will as a record of your wishes

If you need support deciding what to do you contact us by:

DNR (do not resuscitate) form

A living will is not the same as a DNR (do not resuscitate) form.

A DNR form is completed by a doctor to prevent someone from being given inappropriate CPR only. This is different from a living will, which is a form you complete yourself that lets you refuse any medical treatments. 

If you want to refuse CPR then you should ask your GP for a DNR form to be added to your medical records. You should also include your refusal of CPR in your living will.

Related content

There are a few things you can do in advance to tell people what treatment and care you want in the future.

  • Advance statement – used to say what care you do want, for example where you want to live and be cared for
  • DNR form – a form you can only get from your doctor which is used to prevent people being given CPR inappropriately

Page last reviewed: 14 January 2022
Next review due: 14 June 2022