How to make an advance decision

How can I record my advance decision?

You can make an advance decision yourself, in your own words. Unless you want your advance decision to cover the refusal of life-sustaining treatment, you can make it verbally – you can say what you want to happen and don’t have to write it down yourself.

A medical professional can write it down for you and put it on your medical records. You need to specify the treatment you are refusing and the circumstances in which the treatment is not to be given.  

It is always better to make your advance decision in writing, even if it does not relate to refusing life-sustaining treatment. This greatly improves the chance that medical professionals will be aware of your decision and that it is correctly understood.

If your advance decision relates to the refusal of life-sustaining treatment it must always be in writing, and include a statement that it is to apply to the treatment even if your life is at risk.

The advance decision also needs to be signed by you (or another person in your presence and by your direction) in front of a witness, who must also sign as a witness.

There is a template advance decision form. It can be downloaded and filled out, or you can use the form as a guide to write your own if you need more space.

Who should I talk to about my advance decision?

You can talk to your doctor, a solicitor, friends and family, and your insurer about your advance decision. This is so that you can fully understand the consequences of making your advance decision to refuse treatment. These conversations may also help them to understand your decisions. 

Your doctor

You should discuss an advance decision with your GP or hospital doctor before writing it. Ask them to explain:

• how your condition is likely to affect you as it progresses
• what treatment you may need
• the advantages and disadvantages of refusing treatment in advance
• some of the problems that may happen if your decision is unclear.

If you have dementia as well as another condition or conditions, a medical professional can help you to understand the relationship between the conditions and any treatments for them.

It is not necessary for your doctor to sign your advance decision, but it is useful. If there is any confusion, or if your advance decision is challenged, they can explain why you made the decision. The doctor can confirm that you had mental capacity at the time you made it.

Ask your doctor to check your advance decision. They may be able to point out the consequences of your decision that a non-healthcare professional (such as a solicitor) may not recognise. 

A solicitor

You don’t need to talk to a solicitor to make an advance decision, but it can be a good idea. If you are uncertain about what you want to include or how to say it, a qualified solicitor can help make sure that your views are clearly expressed. The more clearly the decision is worded, the more likely it is to be applicable. 

A solicitor will not be able to advise you on how your condition or conditions might progress and the treatments that may be available. For this you should talk to your doctor. 

Friends and family

You don’t have to talk to those close to you about making an advance decision, but it might help you to clarify your own thoughts if you do. It may also make it easier for your friends and family to understand what you want for the future, so that they are prepared when the time comes. 

Your insurer

If you want to make an advance decision to refuse life-sustaining treatment, and have a life insurance policy, check with the insurance company that your policy will not be affected.

What information should I include?

If you choose to write your own advance decision, include the following information:

• your full name
• your address
• your date of birth
• any distinguishing features (for example, tattoos or birthmarks so you can be identified in an emergency)
• the name, address and telephone number of your GP
• your NHS number if you know it
• an explanation of the circumstances in which you want your advance decision to apply
• the specific treatments that you want to refuse
• a statement that says your advance decision was written without pressure from other people 
• if the advance decision applies to refusing life-sustaining treatment, a very clear statement that the advance decision applies to the treatment in question, even if your life is at risk
• the date you made the advance decision
• your signature (or, if you can’t sign, the signature of someone else who signs in your presence and under your direction. The person needs to record that they are signing on your behalf)
• the signature, and the date of the signature of at least one witness aged 18 or over.

You can download and use a template of an advance decision.

Who can be a witness for your advance decision?

A witness is someone who is physically present when you sign and watches you (or someone on your behalf) sign. Ideally this should not be a partner, your husband or wife, relative, anyone who stands to benefit in your will, or your attorney under a Lasting power of attorney.

It’s a good idea to say what their relationship to you is. You could ask a friend or neighbour. If someone is signing on your behalf, they should not be the same person as the witness. 

Including an explanation

It’s a good idea to include an explanation about why you are making the advance decision and what you are trying to achieve. This might involve explaining what is important to you.

For example, you might want to explain that you want to live as long as possible. Or, you might say that quality of life and freedom from pain or prolonged discomfort are more important to you than how long you live. This can make it easier for your family or friends to accept your decision and can also help doctors to understand it.

There is a template advance decision form. It can be filled out, or you can use the form as a guide to write your own if you need more space.