Advance Decision to Refuse Treatment

Advance Decision to Refuse Treatment: Create a Verified Living Will

A verified advance decision to refuse treatment, often called a living will or advance directive, is a written decision that lets you refuse specific medical treatment in the future, in case you can't make or communicate that decision yourself. In many countries, if it is valid and applies to the situation, it is legally binding on doctors and other healthcare professionals. Robot Lawyer drafts your advance decision from your answers under the law you choose, with the signing and witnessing section, guidance notes and a review record. If you want, a legal professional can check it on the Verified plan before you sign.

CONTENTS

What Is an Advance Decision?

An advance decision to refuse treatment (also called an advance directive, advance healthcare directive or living will) is your decision, made while you have mental capacity, to refuse a specific treatment in specific circumstances in the future. It only comes into effect if you lose the capacity to make that decision yourself, for example because of advanced dementia, a severe stroke or being unconscious.

A valid advance decision that applies usually has the same effect as refusing the treatment at the time. Its name, minimum age and signing rules depend on the law you choose, and your document follows them.

An advance decision refuses treatment. It can't force doctors to give a particular treatment or ask for your life to be ended, and in most places it can't refuse basic care, such as warmth, shelter, hygiene and being offered food and water by mouth.

Is an Advance Decision Right for You?

An advance decision is usually right if:

• You know which treatments you would not want
  For example, resuscitation, a breathing machine or tube feeding if you had advanced dementia or were permanently unconscious.
• You have a diagnosis that may progress
  Such as dementia, motor neurone disease, Parkinson's disease or a terminal illness, and want to plan ahead.
• You want your wishes to be binding
  Not just taken into account.
• You are an adult
  Most laws set a minimum age of 18, and a few set a lower one.

It may not be right, or not on its own, if:

• You want someone to make decisions for you
  A power of attorney for health decisions, such as our Lasting Power of Attorney, lets you choose people to decide for you. You can have both, but they need to work together.
• You only want to record general wishes
  Such as where you would like to be cared for. An advance statement of your wishes is not usually legally binding, although it should be taken into account. Your advance decision includes a section for these wishes.
• You live in one country but expect treatment in another
  Choose the law of the place where you are likely to be treated, and take local advice if that is unclear.

Making It Legally Valid

Most laws set similar requirements for an advance decision to be valid and binding:

• You must be an adult with mental capacity
  You must understand the decision and its consequences when you make it.
• It must be specific
  It must say which treatments you refuse and the circumstances in which the refusal applies. Everyday language is fine.
• Refusing life-sustaining treatment usually needs extra formalities
  It should be in writing, say clearly that the decision applies even if your life is at risk, and be signed by you (or by another person in your presence and at your direction) and witnessed. Some laws require two witnesses or a notary.
• It must not be overtaken
  It will not apply if you withdraw it or do something clearly inconsistent with it, and in some places a later power of attorney covering the same treatment replaces it.

Discussing your decision with your doctor is not usually a legal requirement, but it is strongly recommended, and a statement that you had capacity can help if your decision is ever questioned.

What's Included in Your Advance Decision?

• Your details
  Your name, date of birth, address, health service or insurance number and family doctor, so healthcare professionals can identify you.
• The treatments you refuse
  Each treatment, in clear language.
• The circumstances
  When each refusal applies, with any exceptions you want.
• The life-sustaining treatment statement
  Where you choose it, the statement that your decision applies even if your life is at risk.
• Your reasons and wishes
  Why you have made the decision and the care you would still want.
• The person you have appointed
  Whether you have appointed someone to make health and care decisions for you, such as under a power of attorney, and how it fits with your decision.
• Contact details and copies
  Who to contact and who has a copy.
• Signing and witnessing section
  With an optional statement from a healthcare professional.
• Review record and guidance notes
  A table to record each review, and plain-English notes on what to do next.

How It Works in Different Countries

Key differences, in brief (always check the current rules where you live):

• United Kingdom
  In England and Wales, advance decisions are governed by the Mental Capacity Act 2005: you must be 18 or over, and a refusal of life-sustaining treatment must be signed and witnessed. Scotland has no specific statute, but a clear refusal is likely to be respected and can be made from 16. Northern Ireland has no statute in force, but a valid advance decision is binding under the common law.
• United States
  Each state has its own law and often a standard form, called a living will, advance directive or directive to physicians, usually signed before two witnesses or a notary.
• Ireland
  An advance healthcare directive under the Assisted Decision-Making (Capacity) Act 2015 must be in writing, signed and witnessed by two people, at least one of whom is not a family member.
• Canada
  Each province and territory has its own rules and names, such as a personal directive or health care directive. In Quebec, advance medical directives are made before a notary or two witnesses.
• Australia
  Each state and territory has its own law and forms, such as an advance care directive or advance health directive, and in some a refusal made under the common law can also be binding.

How It Works on Robot Lawyer

1. Answer the questions
   Tell us about the treatments you want to refuse, when the refusal should apply and who should know about it.
2. Generate your advance decision
   We draft your advance decision in your own words, following the law you choose.
3. Get it verified (optional)
   Verification is not compulsory. On the Verified plan, a qualified legal professional can check your advance decision within 24 hours and make amendments where needed. Our lawyers are qualified in England and Wales, so for another country's law we also recommend a check by a local lawyer. See how our documents are verified.
4. Sign, witness and share it
   Sign it in front of the witnesses the law requires, give copies to your doctor and the people you trust, and review it regularly.

How Much Does It Cost?

Robot Lawyer is a subscription. Essentials is £13.99 a month and Verified, which includes an optional check of your finished advance decision by a legal professional, is £24.99 a month. Both start with a 7-day free trial. See our pricing.

If your situation is complex, such as a condition where it is hard to describe when treatment should stop, or you want to combine your decision with a power of attorney for health decisions, talk to your doctor or take tailored advice as well.

Advance Decision FAQs

Is a living will legally binding?

In many countries, yes, if it is valid and applies to the treatment and circumstances. Elsewhere, it must at least be taken into account. A general statement of wishes is not usually binding.

Do I need a lawyer to make an advance decision?

Usually not. In most places you can make one yourself, and it doesn't usually need to be registered. What matters is that it is clear, specific and, for life-sustaining treatment, signed and witnessed (or notarised) as the law requires.

Who can witness my advance decision?

In many places, any adult can act as a witness. The witness must see you sign, or see someone else sign for you at your direction, and then sign themselves. It is sensible to choose someone who will not benefit from your death. Some laws need two witnesses, rule out some people as witnesses or allow a notary instead, and your document follows the law you choose.

Can I refuse food and water?

You can refuse clinically assisted nutrition and hydration, such as tube feeding or a drip. In most places, you can't refuse basic care, which includes being offered food and water by mouth.

What is the difference between an advance decision and a DNR form?

A do-not-resuscitate (DNR or DNACPR) form is completed by a doctor and records a clinical decision about resuscitation. An advance decision is your own refusal, and it can cover more than resuscitation.

What if I also have a power of attorney for health decisions?

It depends on the law. In some places, a power of attorney made after your advance decision that covers the same treatment takes priority. In others, your attorney must follow your advance decision. Your document explains how the two fit together.

Can I change or cancel my advance decision?

Yes, at any time while you have capacity. You can usually withdraw it verbally or in writing, although some laws require writing. It is best to destroy the old copies, make a new one and tell everyone who has a copy.

How often should I review it?

Review it regularly, for example every one to two years and whenever your health changes. Your document includes a review record to sign and date each time.

Can I use this in any country?

Yes. Choose the governing law in the first question and your document is drafted for that country or US state, using the local name and signing rules. Our lawyers are qualified in England and Wales, so for another country's law we recommend a check by a local lawyer as well.

Create a Verified Advance Decision

Put your treatment decisions in writing so the people caring for you know what you want. Related documents: Lasting Power of Attorney, Last Will and Testament, Ordinary Power of Attorney, Funeral Plan and Codicil.