Updated: February 2026 · Based on UK Law
What Is Advance Care Planning?
Advance care planning is the process of recording your wishes for future medical treatment if you lose mental capacity, governed by the Mental Capacity Act 2005. It includes advance decisions (legally binding treatment refusals) and advance statements (preferred care wishes).
This guide covers MCA 2005 rules, advance decisions, healthcare preferences, and treatment refusals. Free advance care planning checklist included.
A woman in her early sixties was diagnosed with early-stage dementia. She told her family she did not want to be kept alive on a ventilator if her condition deteriorated. Everyone understood her wishes — but nothing was ever put in writing.
Two years later, when she lost capacity, her family could not agree on her care. Without a valid advance decision or a health and welfare LPA, the hospital made treatment decisions in her “best interests” — including interventions she had clearly said she did not want.
This situation is entirely avoidable. Advance care planning gives you legally recognised ways to record your wishes before you lose the ability to communicate them.
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Types of Advance Care Planning Documents
There are several documents involved in advance care planning, each with different legal status.
- Advance Decision to Refuse Treatment (ADRT): a legally binding document allowing you to refuse specific medical treatments in advance — sometimes called a “living will.” If valid and applicable, healthcare professionals must follow it.
- Advance Statement: a written statement of your wishes, preferences, and values about future care. Not legally binding, but healthcare professionals must consider it when making best interests decisions.
- Lasting Power of Attorney (Health and Welfare): a legal document appointing someone to make health and care decisions on your behalf if you lose capacity, including authority over life-sustaining treatment if you choose.
- Lasting Power of Attorney (Property and Financial Affairs): a legal document appointing someone to manage your finances and property if you lose capacity.
- DNACPR (Do Not Attempt Cardiopulmonary Resuscitation): a specific decision about whether CPR should be attempted if your heart stops — can be part of an ADRT or a separate clinical decision.
Advance Decision to Refuse Treatment (ADRT)
An Advance Decision to Refuse Treatment — sometimes called a living will or advance directive — is a legally binding document under the Mental Capacity Act 2005.
It allows you to refuse specific medical treatments in advance, for situations where you may lack capacity to make that decision at the time.
What treatments can you refuse?
You can refuse any medical treatment, including life-sustaining treatment such as artificial ventilation, artificial nutrition and hydration, antibiotics, or resuscitation.
You cannot refuse basic care such as warmth, shelter, hygiene measures, or the offer of food and drink by mouth.
You also cannot use an ADRT to demand specific treatments — only to refuse them. An ADRT cannot be used to request euthanasia or assisted dying, which remain illegal in England and Wales.
What are the legal requirements for a valid ADRT?
For an Advance Decision to be legally valid under the Mental Capacity Act 2005:
- Age and capacity: you must be 18 or over and have mental capacity at the time you create the ADRT
- Specificity: the ADRT must specify the treatment you are refusing — a general statement like “I don’t want to be kept alive” is not sufficient
- Circumstances: the ADRT should describe the circumstances in which the refusal applies
- Life-sustaining treatment: if your ADRT refuses life-sustaining treatment, it must be in writing, signed by you (or someone at your direction), witnessed, and include a clear statement that the decision applies “even if life is at risk”
An ADRT that does not involve life-sustaining treatment can technically be verbal, but written documentation is strongly advisable.
When is an ADRT not valid?
An Advance Decision will not be valid if:
- You have withdrawn it while you still had capacity
- You have created a Health and Welfare LPA after making the ADRT, giving the attorney authority over the same treatment decisions
- You have done something clearly inconsistent with the ADRT that suggests you changed your mind
- There are reasonable grounds to believe circumstances exist that you did not anticipate, which would have affected your decision
Advance Statements (Statement of Wishes)
An advance statement is a written record of your wishes, preferences, beliefs, and values about your future care.
Unlike an ADRT, an advance statement is not legally binding — but healthcare professionals must take it into account when making decisions about your care.
What can you include in an advance statement?
- Your general wishes about medical treatment
- Where you would prefer to be cared for (home, hospice, hospital)
- Religious or spiritual beliefs that should inform your care
- Personal preferences about day-to-day care
- Who you want (or don’t want) involved in decisions about your care
- Treatments you would prefer to receive in certain situations
The more specific and recent your statement, the more weight it carries. An advance statement can complement an ADRT or LPA by providing context and explanation for your decisions.
Lasting Power of Attorney (Health and Welfare)
A Health and Welfare LPA allows you to appoint one or more people (attorneys) to make decisions about your health and care if you lose mental capacity.
This is different from an ADRT because you are giving someone else the authority to make decisions, rather than making decisions yourself in advance.
What can your attorney decide?
- Day-to-day care decisions (washing, dressing, what you eat)
- Medical treatment decisions
- Where you live and who provides your care
- Life-sustaining treatment decisions (only if you specifically grant this authority)
A Health and Welfare LPA only comes into effect when you lose capacity to make the specific decision in question. Your attorney cannot act while you still have capacity.
Your attorney must always act in your best interests and consider any relevant advance statements or wishes you have expressed.
Which takes priority — an LPA or an ADRT?
ADRT made before LPA: if you make an ADRT and then later create an LPA giving your attorney authority over the same treatment decisions, the ADRT becomes invalid. The LPA takes priority.
LPA made before ADRT: if you have an existing LPA and then make an ADRT, the ADRT is valid. Your attorney cannot consent to treatment you have refused in a valid ADRT.
You can have both an LPA and an ADRT covering different aspects of your care — for example, an ADRT refusing specific treatments, and an LPA giving your attorney authority over other health decisions.
Lasting Power of Attorney (Property and Financial Affairs)
A Property and Financial Affairs LPA allows you to appoint someone to manage your finances, property, and financial decisions if you lose capacity.
What can your attorney do?
- Pay bills and manage bank accounts
- Collect income and benefits
- Buy and sell property
- Manage investments
- Deal with tax affairs
Unlike a Health and Welfare LPA, a Property and Financial Affairs LPA can be used while you still have capacity — if you choose to allow this. This can be useful if you become physically unable to manage your affairs even though you still have mental capacity.
How do you make an LPA?
Both types of LPA must be:
- Made using the official forms from the Office of the Public Guardian
- Signed by you while you have mental capacity
- Signed by your chosen attorney(s)
- Signed by a certificate provider who confirms you understand what you are doing and are not being pressured
- Registered with the Office of the Public Guardian before they can be used
The current registration fee is £92 per LPA. There is a fee exemption or remission scheme for people on low incomes or certain benefits.
DNACPR (Do Not Attempt Cardiopulmonary Resuscitation)
A DNACPR decision is a specific decision about whether CPR should be attempted if your heart stops or you stop breathing.
A DNACPR decision only relates to CPR. It does not affect any other treatment or care you receive.
How are DNACPR decisions made?
- By you in advance, as part of an ADRT
- By your Health and Welfare attorney, if you have granted them authority over life-sustaining treatment
- By healthcare professionals in consultation with you and your family, based on clinical assessment
Healthcare professionals have a legal duty to involve patients in DNACPR decisions. You should always be consulted unless there is a convincing clinical reason not to.
If you disagree with a DNACPR decision made by healthcare professionals, you can ask for a second opinion or make a formal complaint.
The Mental Capacity Act 2005: Key Principles
All advance care planning in England and Wales is governed by the Mental Capacity Act 2005. The Act sets out five key principles.
- Presumption of capacity: you are assumed to have mental capacity unless it is established otherwise — nobody can assume you lack capacity because of your age, appearance, condition, or behaviour
- Support to make decisions: all practical steps must be taken to help you make a decision before anyone concludes you lack capacity
- Unwise decisions: you have the right to make decisions that others might consider unwise — making an unwise decision does not mean you lack capacity
- Best interests: any decision made on behalf of someone who lacks capacity must be made in their best interests
- Least restrictive option: before making a decision for someone, consider whether the outcome can be achieved in a way that is less restrictive of their rights and freedom
How is mental capacity assessed?
The test is whether you can understand the relevant information, retain it long enough to make a decision, weigh up the information, and communicate your decision.
Capacity is assessed for each specific decision at the time that decision needs to be made. You may have capacity for some decisions but not others.
Who Should Consider Advance Care Planning?
Advance care planning is valuable for anyone, but particularly important if you:
- Have a chronic or progressive illness
- Have been diagnosed with dementia or another condition that may affect future capacity
- Have strong views about specific medical treatments
- Want to ensure your family knows your wishes
- Have religious or personal beliefs that affect your treatment preferences
- Want to appoint someone you trust to make decisions on your behalf
Even healthy adults can benefit from advance care planning. Accidents and sudden illness can happen at any age, and having documents in place ensures your wishes are known.
How to Store and Share Your Documents
Advance care planning documents are only useful if healthcare professionals can find them when needed.
- Keep originals safe: store original documents somewhere secure but accessible — tell trusted people where they are
- Give copies to key people: your GP, your attorney(s), close family members, and anyone likely to be involved in your care
- Hospital admissions: if admitted to hospital, tell staff about your advance care documents and ensure copies are placed in your medical records
- Review regularly: review at least every few years, or after any significant change in health or circumstances — add a new date and signature to confirm your wishes are current
- Register LPAs early: LPAs must be registered with the Office of the Public Guardian before they can be used — registration can take several weeks, so do not leave it until you need it
Common Mistakes in Advance Care Planning
These are the errors that most commonly cause problems in practice.
- Being too vague: statements like “I don’t want to suffer” or “I don’t want extraordinary measures” are too vague to be useful — specify which treatments you are refusing and in what circumstances
- Not discussing with family: if your family does not know about your advance care documents, they may be shocked by your decisions or dispute them — discussing your wishes openly can prevent conflict
- Forgetting to register LPAs: an unregistered LPA has no legal effect — registration takes time, so do it well in advance
- Not reviewing documents: medical treatments and your own views may change over time — review regularly to ensure they still reflect your wishes
- Conflicting documents: if multiple documents contradict each other, healthcare professionals may have difficulty determining your wishes — ensure consistency and revoke any that no longer reflect your views
- Making an LPA after an ADRT without understanding the consequences: if you create a Health and Welfare LPA after an ADRT, giving your attorney authority over the same treatment decisions, the ADRT becomes invalid
Frequently Asked Questions
Is an advance care plan legally binding?
It depends on the document. An Advance Decision to Refuse Treatment (ADRT) is legally binding under the Mental Capacity Act 2005, provided it meets the requirements for validity.
An advance statement of wishes is not legally binding, but healthcare professionals must consider it when making best interests decisions.
Do I need a solicitor for advance care planning?
Many complete advance care planning documents without one. Our templates are structured following the Mental Capacity Act 2005 and include clear guidance throughout.
Consider solicitor review if your circumstances are complex, you have conflicting documents, or you want extra peace of mind. Your choice based on your situation.
Can I change or withdraw my advance decision?
Yes. You can change or withdraw an advance decision at any time while you still have mental capacity. There is no formal process required — but it is best to do so in writing and inform anyone who holds a copy.
What happens if I have an ADRT and an LPA?
The order in which you create these documents matters. If you make an ADRT first and then create a Health and Welfare LPA covering the same treatment decisions, the ADRT becomes invalid.
If you create the LPA first and then make an ADRT, the ADRT is valid and your attorney cannot consent to the treatment you have refused.
How much does it cost to register an LPA?
The current registration fee is £92 per LPA, payable to the Office of the Public Guardian. If you need both types of LPA, the total is £184.
Fee exemptions are available for people receiving certain means-tested benefits, and a 50% remission is available if your gross annual income is below £12,000.
Can my family override my advance decision?
No. If your ADRT is valid and applicable to the treatment in question, healthcare professionals must follow it — even if your family disagrees. This is one reason why discussing your wishes with family in advance is so important.
Does an ADRT apply in Scotland or Northern Ireland?
The Mental Capacity Act 2005 applies to England and Wales only. Scotland has its own legislation under the Adults with Incapacity (Scotland) Act 2000. Northern Ireland passed the Mental Capacity Act (Northern Ireland) 2016, which takes a different approach.
Can I use an advance decision to refuse all treatment?
You can refuse any specific medical treatment, but you cannot refuse basic care. An ADRT must be specific about which treatments you are refusing and the circumstances in which the refusal applies.
The Truth About “Free” Legal Template Sites (What You’re Really Signing Up For)
Most websites offering a “free legal template” follow the same pattern:
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Why These “Free” Templates Are a Legal Risk
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Hidden Problem: Many “Free Template” Sites Aren’t Even UK-Based
Another major issue is that many free or auto-subscription template sites operate outside the UK and use documents originally drafted for the US legal system. These are then loosely adapted for “international use,” which creates serious problems:
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Last updated: February 2026
Disclaimer: This guide provides general UK legal information, not legal advice. Laws are current as of February 2026.
