An Advance Decision gives a person the opportunity to make decisions now about specific treatments they may not want to receive in the future. This ensures that if somebody is unable to make their own decisions about treatment, that they are not forced to receive any treatment they do not want.
Treatments that can be refused include life-sustaining treatment. For example, some people may write an Advance Decision to refuse a blood transfusion for religious reasons.
The person making the Advance Decision must be over 18 and have mental capacity at the time they make it, otherwise it will not be valid.
Doctors and medical professionals will have to follow an Advance Decision provided it is valid and applicable.
For an Advance Decision to be applicable the wording has to be specific and relevant to the medical circumstances. If the wording is vague or there is concern that it does not refer to medical conditions or medical practices that the person is experiencing at that time, then the Advance Decision may not influence the doctors’ decisions.
The Advance Decision must be clear; must not be made under the influence of other people; and the person making it must be fully informed on the consequences of refusal of treatment, including that it may hasten death.
The Advance Decision must be written down and be signed by the person making it in front of a witness.
An Advance Decision cannot be used when a person has the capacity to give or refuse consent themselves and must not be used for anything that is against the law (for example, euthanasia or assisting a person to take their own life).
Copies of a signed Advance Decision should be given to the person’s GP to keep with their medical records; hospital or medical staff to keep with their case notes; close relatives and friends interested in their welfare; and any attorneys named in a Health and Welfare Lasting Power of Attorney.
An Advance Decision cannot be overturned unless a Health and Welfare Lasting Power of Attorney has been signed after the Advance Decision and gives the attorneys authority to give or refuse consent to life-sustaining treatments to which the Advance Decision relates or the person decides not to follow the Decision when they still have mental capacity.
Living Wills written prior to the Mental Capacity Act 2005 may continue to be valid provided they meet the new rules. If a Living Will includes a decision on life-sustaining treatments it must be in writing and qualify as per an Advance Decision.
DO NOT RESUSCITATE – to sign or not to sign
Many believe a Do Not Resuscitate (DNR) or Do Not Attempt to Resuscitate (DNAR) only comes into effect if you are on a life support machine with no prospect of recovery.
A signed DNR instructs doctors and paramedics not to give you CPR if your heart stops. You can still be given other forms of treatment.
The law does not require a patient, or their family, to consent to a DNR. This means a doctor can issue one, even if you do not want that. The law limits the use of DNRs in certain circumstances and gives patients a right to be involved in the decision-making progress. Patients therefore have no right to demand that a doctor provides CPR if that doctor does not believe it would be in their patient’s best interests and would not be successful.
If you have signed a DNR or are thinking about signing one, we strongly recommend you first research this and discuss it with your doctor.
The law on organ donation in England has now changed.
The Organ Donation (Deemed Consent) Act 2019 came into effect on 20 May 2020.
From this date, if you do not wish your organs to be donated, you must opt out. If you do not opt out, it will automatically be assumed that you opt in.
If you wish to opt out, you must register your wishes in this respect on the NHS Organ Donation Register which can be found online at:
You should also advise your family and friends of your wishes.