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Advance Decision to Refuse Treatment

See also Advance Decision (Living Will) on the NHS website. The information in this section is taken from this website.

1. Introduction

An advance decision to refuse treatment is also known as an advance decision or a living will.  It is a decision that you can make now to refuse a particular type of treatment at some time in the future.

It is an official record that lets your family, carers and health professionals know whether you want to refuse a particular type of treatment/s in the future. This means that they will know what your wishes are, if you become unable to make or communicate those decisions yourself at any point after you have made it.

Deciding to refuse a treatment is not the same as asking someone to end your life or to help you end your life. Euthanasia and assisted suicide are illegal under English law.

2. What Treatment can you Refuse?

You may want to refuse a treatment in some situations, but not others. If so, you need to be clear about all the circumstances in which you want to refuse this treatment.

You can refuse a treatment that could potentially keep you alive (known as life-sustaining treatment). This includes treatments such as ventilation (a machine that helps someone breathe) or cardio pulmonary resuscitation (CPR), which is used  if someone’s heart stops.

The treatment/s that you decide you do not want (that you ‘refuse’) must all be named in the advance decision.

An advance decision to refuse treatment is not the same as an advance statement. Click on this link to read about Advance Statements.

3. Who Can Make an Advance Decision?

You can make an advance decision to refuse treatment, as long as you have the mental capacity to make such decisions. Click on this link to find out more information about What is Mental Capacity?

It may only be considered valid if:

  • you are aged 18 or over and had the capacity to make, understand and communicate your decision when you made it;
  • you specify clearly which treatments you wish to refuse;
  • you explain the circumstances in which you wish to refuse them;
  • it is signed by you and by a witness if you want to refuse life-sustaining treatment;
  • you have made the advance decision of your own accord, without any harassment by anyone else;
  • you haven’t said or done anything that would contradict the advance decision since you made it (for example, saying that you have changed your mind).

4. Life-Sustaining Treatment

Life-sustaining treatment is treatment that replaces or supports ailing bodily functions. They can vary and include, for example, a mechanical ventilator that can help you to breathe or antibiotics can help your body fight infection. It is sometimes called life-saving treatment.

If you want to refuse life-sustaining treatments in circumstances where you might die as a result, you need to state this clearly in your advance decision. It needs to be:

  • written down;
  • signed by you;
  • signed by a witness.

You may find it helpful to talk to a doctor or nurse about the kinds of treatments you might be offered in the future, and what it might mean if you choose not to have them.

5. Is an Advance Decision to Refuse Treatment Legally Binding?

Yes, as long as it:

If your advance decision is binding, it takes the place of decisions made in your best interest (see Best Interests) by other people.

6. How does an Advance Decision to Refuse Treatment Help?

As long as it is valid and applies to your situation, an advancd decision to refuse treatment gives your health and social care team clinical and legal instructions about what treatment you want and do not want if you are no longer able to communicate your decisions.

An advance decision will only be used if, at some time in the future, you are not able to make your own decisions about your treatment.

7. Does the Advance Decision to Refuse Treatment need to be Signed and Witnessed?

Yes it does, if you are choosing to refuse life-sustaining treatment – in which case, the advance decision must be written down, and both you and a witness must sign it.

You must also include a statement that the advance decision applies even if your life is at risk.

8. Who should See the Advance Decision?

You have the final say on who sees it, but you should make sure that your family, carers, and / or health and social care professionals know about it, and know where to find it.

You can keep a copy in your medical records.

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