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Living Wills: what they are & how to make an Advance Decision

Living Wills: what they are & how to make an Advance Decision

A Living Will, or Advance Decision, allows a person to express their wishes regarding future medical treatment and whether they wish to refuse it. It is legally binding and will guide medical professionals should a person become unable to communicate their wishes. 

In this guide we explain what it is, how to make one and why it is different to an Advance Statement and a Lasting Power of Attorney.  

living will advance decision

What is a Living Will?

A Living Will, legally referred to as an Advance Decision to refuse treatment (ADRT), is made in case there comes a time when you are unable to communicate your wishes concerning specific medical treatments you wish to refuse, and the circumstance in which you would refuse them.

It is legally-binding (in England and Wales) but will only be used if you lose the capacity to communicate or make decisions for yourself. People may decide to make an Advance Decision if they have a terminal illness and want to refuse CPR, or because they have a specific objection to a type of treatment such as being fed by a tube or having blood transfusions. You might just want to make one as part of your broader end of life planning. The decisions that you make in an Advance Decision around the refusal of treatment will be followed by medical professions, even if it means you might die.

Examples of what can and can't be included in a Living Will

You can use a Living Will to make requests about the future treatment you want and don’t want to receive. However, there are somethings that you can’t request in a Living Will. 

You can refuse...

  • resuscitation
  • being put on a life support machine
  • being fed artificially
  • having a blood transfusion

You can't...

  • request a certain treatment
  • refuse care for your comfort or pain relief
  • refuse food/drink through the mouth
  • nominate someone to make decisions for you
  • ask for help in ending your life
  • refuse treatment for a mental health condition

How to make a Living Will (Advance Decision)

There is no set protocol to follow when writing a Living Will (unless you are refusing life sustaining treatment – see below), however, if it is not clear or there are contradictions a doctor can decide that it is not valid.

We have written a step-by-step guide on making a Living Will with advice on what makes a Living Will legal and valid, who you should consult, and what you should include. 

Living Wills and Lasting Power of Attorney

A Living Will can’t be used to state that you wish for someone else to make decisions on your behalf, should you not have the mental capacity to do so. To do this you will need to have a Lasting Power of Attorney (LPA) for health and welfare in place.

As well as agreeing to or refusing medical treatment (including life sustaining treatment if you wish), A LPA can also include other welfare decisions, such as where you live and who you socialise with.

If you appoint an attorney to act as your Power of Attorney, they should always make decisions in your best interests.  A best interest decision will include considering information that you have previously communicated about what you would want in certain situations.

A Health and Welfare Lasting Power of Attorney must be registered with the Office of the Public Guardian to be valid and this process will take at least 8-10 weeks. It is advisable to have it prepared and registered before it is likely to be needed so that it can be used in an emergency situation. It also costs £82 to register an LPA, without taking into account any Solicitor fees.

Living Will FAQs

Q.

Do I need to involve a doctor or solicitor when making a Living Will?

A.

You do not have to involve either a doctor or solicitor when making a Living Will. However, we do strongly recommend at least consulting your GP or medical team to make sure your wishes are clear. If there is any doubt or contradiction, the medical team can decide it's not valid. 

Q.

Does an Advance Decision need to be in writing?

A.

An Advance Decision (Living Will) only has to be in writing if you wish to refuse life sustaining treatment e.g. resuscitation. The NHS strongly advises that your Advance Decision be in writing to ensure that your wishes are followed should it be needed.  

Q.

Where do I store a Living Will?

A.

Your GP should have a copy of your Living Will and it is a good idea to either give a copy to close friends or family or to let them know where it is stored, so that it can be accessed quickly if needed. 

Q.

What is the difference between Euthanasia and Advance Decisions?

A.

Euthanasia is the act of deliberately ending someone's life to relieve suffering.  You are not able to request to end your life in a Living Will. Euthanasia (and assisted suicide) is illegal in the UK. 

Q.

I made a Living Will before 2007 - what should I do?

A.

The Mental Capacity Act came into force in late 2007, changing Living Wills to Advance Decisions. If you made a Living Will before then, and haven't updated it since, we highly recommend you make a new one to be assured that it remains valid. 

Q.

Is an Emergency Care Plan the same thing?

A.

An Emergency Care Plan (ECP) is a plan of action written up by your healthcare professionals, in meetings with you, to explain and summarise recommended treatment plans in case of an emergency. An ECP should include a reference to any Advance Decision you have made. 

Q.

Can I have both an Advance Decision and Lasting Power of Attorney?

A.

It is possible to have both documents but the date order that you make the documents in could cause portions of the older document to become invalid. A LPA is a more comprehensive approach however, it is more expensive to make and requires the help of a solicitor. 

Q.

How much does a Living Will cost?

A.

It does not cost anything to make a Living Will. If you choose to consult a solicitor in the making of one, you will have to pay their fees. We don't think making an Advance Decision should take longer than an hour, so it shouldn't cost more than an hourly rate. 

Q.

What about Do Not Resuscitate (DNR) orders?

A.

A Do Not Resuscitate order is actually quite an outdated name, and is considered inaccurate. It is now better know as an Do Not Attempt Cardiopulmonary Resuscitation (CNACPR) order. Only a doctor can make this order, but they can include it as part of an Advance Decision to refuse treatment (ADRT), or Living Will, after consulting with you. A CNACPR on its own is technically not legally binding, however, as part of a Living Will, it is. 

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