How can you make your wishes known if one day you cannot speak for yourself? An Advance Statement and an Advance Decision are two ways to plan ahead for your future care in England and Wales. This guide explains what an Advance Statement is, how an Advance Decision to refuse treatment differs, and how both work alongside a Lasting Power of Attorney.
What is an Advance Statement?
An Advance Statement is a written statement of your preferences, wishes, beliefs and values about your future health and social care. It guides the people who may need to decide for you if you cannot make or communicate decisions yourself.
For example, it might say where you would like to be cared for, what you like to eat, or which routines matter to you. In short, it helps others understand what is important to you as a person.
What an Advance Statement can cover
Advance Statements are flexible. They can cover:
- daily care preferences, such as preferring a shower to a bath, or sleeping with a light on
- where you would like to be cared for, such as at home, in a particular care home or in a hospice
- religious or spiritual beliefs you would like respected in your care
- practical matters, such as who should look after your pets
For example, an illustrative Advance Statement might say: “I would prefer to be cared for at home for as long as possible. If that is not practical, I would like to move to a care home close to my family. I am vegetarian and would like this diet to continue.”
Is an Advance Statement legally binding?
No. However, anyone deciding in your best interests must consider your past and present wishes, feelings, beliefs and values. This is a requirement of the Mental Capacity Act 2005. So a written statement carries real weight. Think of it as a clear guide rather than a strict set of rules.
An Advance Statement does not need witnesses or a particular format. Even so, signing and dating it makes it clearer that it reflects your own considered views.
What is an Advance Decision?
An Advance Decision to Refuse Treatment, sometimes informally called a “living Will”, is a decision made now to refuse a particular medical treatment in circumstances you describe. It only applies if you later lack the capacity to make that decision yourself. If it is valid and applies to the situation, it is legally binding under the Mental Capacity Act 2005.
What an Advance Decision can and cannot do
For example, you might use an Advance Decision to refuse blood transfusions, clinically assisted nutrition or hydration, certain types of surgery, or cardiopulmonary resuscitation (CPR).
However, an Advance Decision cannot be used to:
- demand a particular treatment
- refuse basic care, such as warmth, shelter and keeping you clean and comfortable
- ask for help to end your life
Assisting suicide remains a criminal offence in England and Wales under the Suicide Act 1961. The Terminally Ill Adults (End of Life) Bill has not become law. A new bill for the 2026–27 session was introduced on 17 June 2026. So the position may change, but the current law has not.
Refusing life-sustaining treatment
You can refuse life-sustaining treatment, but extra formal rules apply. The Advance Decision must:
- be in writing
- carry your signature, or that of someone signing in your presence and at your direction
- have that signature made in front of a witness, who also signs in your presence
- include a clear statement that the decision applies even if your life is at risk
The witness does not need to be independent. Even so, it is sensible to choose someone who will not be affected by the decision.
When professionals may not be bound
Doctors must follow a valid Advance Decision that applies to the situation. However, they may not be bound by it if you have since acted in a way clearly inconsistent with it. The same applies if there is reasonable doubt about whether it is valid or applies. It may also not apply where new circumstances arise, such as medical advances, that you did not foresee and that would have changed your decision.
Advance Statements and Advance Decisions compared
- An Advance Statement sets out general preferences and wishes about care. It is not legally binding, but it must be taken into account.
- An Advance Decision refuses specific medical treatments in specified circumstances. It is legally binding if valid and applicable, and it covers medical treatment only.
Many people find it helpful to have both, or to discuss them with their GP or specialist. That way, the medical wording is clear and covers the situations they have in mind.
Who can make one?
Anyone aged 18 or over with mental capacity can make an Advance Statement or an Advance Decision. In this context, capacity means being able to understand, retain and weigh up the relevant information, and to communicate your decision.
The Mental Capacity Act 2005 starts from the assumption that a person has capacity unless it is shown otherwise. If you have concerns about your own capacity, or a loved one’s, a good first step is to speak to your GP or the professionals involved in their care.
Storing, sharing and reviewing your documents
You decide who sees your documents, but they only work if the right people know about them when needed. So consider:
- asking your GP to add a copy to your medical records
- sharing copies with the professionals involved in your care
- telling trusted family members or friends
- giving a copy to your attorneys, if you have a Health and Welfare LPA
- carrying a card saying you have an Advance Decision and where to find it
Also review them regularly, especially after changes in your health or circumstances. You can change or withdraw an Advance Statement or Advance Decision at any time while you have capacity.
How they work with a Lasting Power of Attorney
A Health and Welfare Lasting Power of Attorney lets you choose the people who will make decisions for you if you lose capacity. An Advance Statement then tells them what matters to you, so they can make the choices you would have made.
With an Advance Decision, the order in which you make the documents matters:
- LPA made after the Advance Decision: the LPA overrides the Advance Decision, but only if it gives your attorneys authority over the same treatment. For life-sustaining treatment, the LPA must expressly give that authority.
- Advance Decision made after the LPA: the Advance Decision takes priority for the treatments it covers.
Because of this, it is important to think about the documents together. An LPA must be made while you still have capacity, and it can only be used once the Office of the Public Guardian has registered it. Registration currently takes around 8 to 10 weeks. The GOV.UK guide to Lasting Powers of Attorney explains the process, and the Mental Capacity Act 2005 sets out the law.
Lasting Powers of Attorney with A.D.E. Wills
A.D.E. Wills prepares Health and Welfare and Property and Financial Affairs LPAs for a fixed fee, shown on our LPAs Pricing page, plus the OPG fee of £92 per LPA. You can read more on our Lasting Powers of Attorney page.
If you would like to talk about planning for your future care, your initial chat is free and can be online or over the phone. Call 01865 507174 or email info@adewills.co.uk.
