Advance Care Directive: Making a Living Will | 2025

An Advanced Care Directive is more commonly known as a Living Will or Advanced Decision. It is a written statement which only takes effect when a person is unable to make or communicate their decisions themselves. 

Key Points

• What it is: A legal document that records your wishes about medical treatment and end-of-life care if you lose capacity.
• Who it’s for: Anyone aged 18 or over who wants control over their future healthcare decisions.
• Legal status: Recognised under the Mental Capacity Act 2005 in England and Wales.
• Why it matters: It helps your loved ones and doctors know exactly what care you do or do not want.

What is an Advance Care Directive?

An Advance Care Directive (ACD) is a written statement that sets out your preferences for future medical treatment and personal care.

It can include:

• Preferences as to a person’s future medical treatment, especially regarding life-sustaining treatment and other treatments they wish to refuse, such as CPR
• Your values and beliefs that should guide your care
• Where you would prefer to be cared for – home, hospice, hospital
• Who should make decisions for you if you can’t

These details are used to guide medical professionals and their families to ensure that when in care their wishes are followed. This lessens the burden on their families to make difficult decisions during stressful times and will provide the person with peace of mind.

In England and Wales, an Advance Care Directive is legally known as an Advance Decision to Refuse Treatment (ADRT) if it specifically refuses certain treatments.

In Scotland, similar wishes can be expressed through an Advance Statement.

Who can make one?

You can make an Advance Care Directive if:

• You are 18 or older (16 or older in Scotland)
• You have mental capacity to understand what it means
• You make it voluntarily (not under pressure)

How to make an Advance Care Directive?

There’s no official government form to fill in, but the ACD must:

• List your values and preferences. So think about what kind of care you would want or not want if you became seriously ill. Discuss your plans with your family and your GP.
• Write your directive. For this you can use templates from NHS England, Compassion in Dying or Age UK.
• Share copies with your GP, next of kin, and anyone who might be involved in your care.
• Be in writing
• Be signed and dated by you
• Clearly state the circumstances in which you would refuse treatment
• Be witnessed if it includes refusal of life-sustaining treatment

How to make sure your Living Will is legally binding

In order for the Directive to be deemed legally binding in England and Wales, it must satisfy the requirements specified under the Mental Capacity Act 2005.  These requirements are:

• Made by a person over the age of 18 years 
• Able to make, understand and communicate their wishes at the time the directive is created, 
• It must be a clearly written document specifying the treatments to be refused, pain management and sometimes often forgotten their religious or cultural beliefs, 
• It must be made at the person’s own free will without influence or pressure from a third party; and 
• The circumstances recorded therein must not contradict an LPA later created by that person.

It is not always mandatory to have the Directive witnessed but, when making decisions to refuse life sustaining treatment, it is always recommended to have the Directive witnessed.

Why should you make an Advance Care Directive?

It is important to make an Advance Care Directive as it will help:

• Ensure your wishes are respected if you do become seriously ill
• Prevent unwanted or invasive treatments
• Ease any stress for your family and healthcare professionals
• Ensure you are given compassionate, personalised end-of-life care

It gives you peace of mind knowing that even if you can’t speak for yourself, your choices still matter.

How does an Advance Care Directive differ from a Lasting Power of Attorney?

Although the Advance Care Directive is used when a person is unable to make decisions, it differs from a Lasting Power of Attorney (LPA).  

An LPA for Property and Financial affairs only allows a solicitor to manage a person’s property and money. An LPA for Health and Welfare only allows a solicitor to make decisions regarding a person’s daily medical care and routine, such as washing, dressing and moving into a care home. 

Can a Directive be challenged?

An Advance Directive can be challenged or overruled:

• If the requirements within the Mental Capacity Act 2005 are not met and there are issues with a lack of mental capacity

• Ambiguous and unclear instructions so the Advance Care Directive can be interpreted in different ways

• The circumstances/treatment do not relate to the instructions within the Directive. 

• The Directive can also be overruled if the person is being held under the Mental Health Act or in cases of an emergency to sustain life or prevent serious deterioration.

What could happen if I don’t have a Living Will?

If you have not made an advance decision and made your wishes clear about future treatments, healthcare professionals will be unaware of these.

In this case, you will not have the same control over decisions made about your care in the future. This then could result in a number of complications, including being kept alive against your will.

This could mean heartbreak both for you and your family members and friends.

Should I review my Advance Directive?

To ensure that your Directive is not challenged in any way it is always advised that your Directive is reviewed every two years, if there are changes to family life e.g. divorce, a loved one’s death or if there are any significant changes to your health.

Where to store your Advance Directive?

The main place to store your Directive is with your medical records as your GP will be responsible for the holding and management of the document. 

The Directive can also be referred to within your LPAs and a copy will be held by your Solicitor.  This will be passed to your family once you are no longer able to make decisions for yourself.

Seeking professional advice

We always advise that you seek professional advice when creating an Advanced Directive. This is especially so when you are wanting to refuse life sustaining treatment. 

This ensures that your wishes are accurately documented and legally binding.

By instructing a Solicitor, they can verify capacity at the time the document is created. This will ensure the document meets all the legal requirements. It will also ensure it coordinates with any other legal documents that you may already have in place and that your specific choices are clearly expressed to prevent any confusion or challenges at a later date.

As well as instructing a Solicitor, it is also advised that you consult with a Medical Professional to fully understand the implications of your decisions, the likely effects that may occur if you refuse or choose to stop any specific medical treatment. They can provide further information to be included within the Directive.

If you need further advice on Advance Care Directives, from Marisa Geesing at RG Law, you can contact her on 01904 234095 or marisa.geesing@rglw.co.uk.