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How to make an advance decision (ADRT) — UK living will

In short. Write down which specific treatments you would refuse in which circumstances, sign in front of a witness, and lodge a copy with your GP and on the NHS Summary Care Record. For life-sustaining treatment, the words 'even if my life is at risk' are required.

An advance decision to refuse treatment (ADRT) is governed by ss24–26 Mental Capacity Act 2005 in England and Wales. It only refuses treatment — it cannot demand treatment, refuse basic care, or override the Mental Health Act. Done properly, it is binding on clinicians once it is shown to be valid and applicable.

Last reviewed:

·Estimated time: 14 days·Cost: £0 (template) or £150–£400 (solicitor)

What you'll need

  • A clear list of treatments you would refuse and the circumstances
  • One adult witness
  • Your GP details and NHS number

The steps

  1. 01

    Decide what you want to refuse and when

    Be specific. 'I refuse mechanical ventilation if I am in the advanced stage of motor neurone disease and unable to communicate' is enforceable; 'I don't want to suffer' is not. List each treatment and the circumstance in which the refusal applies.

    Official link →

  2. 02

    Use a recognised template

    The NHS, Compassion in Dying and Marie Curie publish free ADRT templates that prompt for everything legally required. Templates make it harder to overlook the 'even if my life is at risk' wording needed for life-sustaining treatment.

  3. 03

    Sign with a witness

    For a general ADRT (non-life-sustaining), writing is recommended but not mandatory. For any refusal of life-sustaining treatment it must be in writing, signed by you (or someone in your presence at your direction), witnessed by one adult, and include the explicit 'even if my life is at risk' wording.

  4. 04

    Tell your GP and add to your Summary Care Record

    Give a copy to your GP and ask for it to be flagged on your record. Ask whether your Summary Care Record can include the ADRT — emergency clinicians look here first when you arrive unconscious.

  5. 05

    Share copies and review regularly

    Give copies to family, your Health & Welfare attorney (if you have an LPA), and anyone likely to be contacted in an emergency. Review the document at least every few years and after any major change in your health.

Common pitfalls

  • Refusing life-sustaining treatment without the 'even if my life is at risk' wording — that part of the ADRT is unenforceable
  • Making an ADRT, then later registering a Health & Welfare LPA giving the attorney power over the same treatment — the LPA overrides the ADRT
  • Storing the ADRT in a place no-one knows about — emergency clinicians will fall back on a best-interests decision
  • Trying to use an ADRT to ask for treatment, refuse basic care, or request assisted dying (which remains unlawful in England, Wales and Northern Ireland)

FAQ

Do I need a solicitor?
No, but a solicitor experienced in capacity work is helpful for complex situations — for example a progressive illness where the trigger conditions need careful drafting, or where you also want a Health & Welfare LPA aligned with the ADRT.
Does an ADRT need to be registered?
No central register exists. The practical equivalent is your Summary Care Record and your GP file. Make sure both reflect the current version.
Can family override my ADRT?
No. A valid and applicable ADRT is binding on clinicians and cannot be overridden by family. Clinicians may still consult family for context, but the legal decision rests on the ADRT.
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