How to Create an Advance Decision to Refuse Treatment in the UK: A Complete Guide

How an Advance Decision Becomes Legally Binding in the UK

Planning ahead for your healthcare is empowering. Knowing how to create an advance decision to refuse treatment in the UK means you can make clear choices about your medical care now, which will guide decisions if you cannot speak for yourself in the future.

This article, brought to you by My Medical Choice, provides practical steps, legal context, and compassionate support to help you understand your options and make confident decisions.

Key Takeaways

• An advance decision allows you to refuse specific medical treatments in the future.
• You must have capacity at the time you make it. nhs.uk
• Life‑sustaining treatment refusals require specific wording, signatures and a witness.
• There is no central UK register, making sharing and recording essential.
• You have the right to refuse medical treatment under UK law. nhs.uk
• Digital systems such as My Medical Choice make updating easier.

Understanding Advance Decisions and Why They Matter

An advance decision (sometimes called an ADRT or advance directive) is a formal declaration that specifies the medical treatment or treatments you do not want to receive in the future if you lose the ability to make or communicate decisions. It is legally recognised in England and Wales under the Mental Capacity Act 2005. Legislation.gov.uk

It ensures your choices are respected and reduces the burden on families who might otherwise struggle to interpret your wishes, especially during emergencies.

How to Create an Advance Decision to Refuse Treatment in the UK

Step One: Confirm You Have Capacity

You must be aged 18 or over and have the mental capacity to understand your choices at the time you make an advance decision. You need to understand what is being refused, what it means, and the consequences of your choices. nhs.uk

Step Two: Be Specific

Your advance decision must clearly state:

• What treatment(s) you are refusing
• The exact circumstances in which the refusal applies

For example, you might refuse certain antibiotics only if you are permanently unconscious.

Being specific improves clinical understanding and helps reduce ambiguity.

Step Three: Refusing Life‑Sustaining Treatment

If you are refusing life‑sustaining treatment such as ventilation or CPR, the advance decision must:

• Be in writing
• Be signed by you
• Be witnessed
• Clearly state that it applies even if your life is at risk

These additional requirements ensure the advance decision is legally binding in those circumstances.

Step Four: Communicate Your Decision

An advance decision is only useful if others know about it. Discuss it with:

• Your GP
• Members of your healthcare team
• Close family or carers

Clear communication ensures your wishes are accessible when they need to be.

How to Register an Advance Directive Refusing Specific Treatments

There is no central national register for advance decisions in the UK, so taking steps to ensure your document is available is important.

Share With Your GP Practice

Once your advance decision is complete, it is strongly advised that you email or hand it to your GP practice. Ask them to add it to your NHS medical records.

This is crucial because your GP record is often accessed in urgent medical situations.

Share With Trusted People

You should also:

• Give copies to family, carers, or appointed representatives
• Keep your own copy in a safe but accessible place

Advance decisions only work if they are known and accessible when needed.

Your Right to Refuse Medical Treatment Under UK Law

Your right to refuse medical treatment in the UK is well recognised. If you are competent, you can refuse any medical treatment, even if this could lead to serious harm or death.

This right is grounded in:

• The Mental Capacity Act 2005, which provides the legal basis for advance decisions and protects your autonomy. Legislation.gov.uk
• Healthcare practitioners must respect a valid, applicable advance decision.

If You Have No Advance Decision

If you lose the ability to decide and you do not have a valid advance decision, treatment decisions will be made in your best interests under the Mental Capacity Act.

Limitations and Exceptions

There are some exceptions, particularly under the Mental Health Act 1983 for certain situations such as compulsory treatment for mental disorders. This does not negate your overall right to refuse treatment but creates some narrow legal exceptions.

Compassionate Planning and Personal Empowerment

Creating an advance decision is not about giving up care. It is about expressing your personal values and treatment preferences clearly and confidently.

Planning ahead can:

• Reduce stress and uncertainty
• Free your loved ones from difficult guesswork
• Ensure your priorities are understood and respected

These discussions can also improve relationships and clarify expectations.

Best Online Platforms for Booking Consultations About Refusing Treatment

Many people seek support when planning advance decisions or discussing treatment refusal. Here are trusted ways to get professional input:

My Medical Choice Online System

My Medical Choice provides a dedicated online system to help you prepare and update your Advance Decision Notice (ADN). This tool allows you to:

• Complete your ADN online with structured support
• Review and revise it as your circumstances or preferences change
• Keep your choices clearly documented

A key benefit of the My Medical Choice system is its electronic nature, allowing you to revise your ADN at any time. Once completed, you should email or hand it to your GP practice so that it becomes part of your medical note.

… Below is a screenshot from one of the pages in the My Medical Choice digital AND form.

NHS Services

The NHS App lets you book appointments or contact your GP for advice on treatment decisions, though it does not create advance decisions itself.

Private Consultations

Some platforms such as private GP services allow you to book consultations to discuss your situation if you need more time or personalised advice.

Support organisations and charities often provide additional guidance and resources that accompany clinical advice.

Real World Examples

Planning With Confidence

Oliver, aged 75, used the My Medical Choice system to complete his Advance Decision Notice. After sharing it with his GP and family, his wishes were respected during a later hospital stay when he was unable to communicate.

Sharing Matters

A My Medical Choice blog post highlights what can happen when advance decisions are overlooked. This underscores why sharing documentation with your GP, family and care team is essential for effective implementation. (See supporting blog – When an Advance Decision Is Overlooked: A Wake-Up Call for Us All)

Summary Table: Advance Decisions at a Glance

Frequently Asked Questions

What is an advance decision to refuse treatment in the UK?

An advance decision is a legal document that allows you to refuse specific medical treatments in the future if you are unable to communicate or make decisions for yourself.

Can I change my advance decision later?

Yes. You can amend or withdraw it at any time while you have capacity. nhs.uk

Is an advance decision legally recognised by the NHS?

Yes. A valid and applicable advance decision is legally recognised in England and Wales under the Mental Capacity Act 2005 and must be respected by healthcare professionals.

Does refusing treatment mean no care at all?

No. Comfort care, pain relief and emotional support should continue even if you have refused specific treatments.

Do I need a solicitor to make an advance decision?

No. Most people do not need legal advice to create an advance decision, although some may choose to seek additional reassurance if their situation is complex.

What happens if I do not have an advance decision?

If you lose capacity and do not have an advance decision, medical decisions will be made in your best interests under the Mental Capacity Act, often involving clinicians and family members.

Can I refuse life-sustaining treatment in an advance decision?

Yes, but additional legal requirements apply. Refusals of life-sustaining treatment must be written, signed, witnessed (as per the My Medical Choice ADN form), and clearly state that the refusal applies even if life is at risk.

Can I change or cancel my advance decision later?

Yes. You can amend or withdraw your advance decision at any time while you have mental capacity.

How do doctors know about my advance decision in an emergency?

Advance decisions are most effective when shared with your GP and healthcare team and added to your medical records. There is no central UK register, so sharing is essential.

Take Control of Your Future Healthcare

Creating an advance decision is a valuable act of self-care and compassion. It lets you express your choices clearly and empowers you to shape your future healthcare.

My Medical Choice offers a wide range of downloadable resources to assist you in preparing for hospital visits, elective procedures, and medical planning more generally. Many of these documents are available exclusively to members, while others are freely accessible through our blog. These resources are designed to support informed, confident decision-making.

If you’d like more guidance on related topics, such as supporting patient choice in healthcare planning, you might find these My Medical Choice blog posts useful:

• Supporting Patients’ Choice Through Clearer Healthcare Planning
• Healthcare planning family meeting
• Advance Decision Notice vs. Medical‑Legal Protection Systems

Please note that My Medical Choice is a digital platform and does not provide direct individual support or personalised advice.

Citations & References Section

Add a short section listing authoritative sources you cited:

• NHS guidance on advance decisions to refuse treatment nhs.uk

• Mental Capacity Act 2005 overview Legislation.gov.uk

Reviewed: December 2025

Last updated: December 2025

This article was reviewed and edited by the My Medical Choice content team, with reference to NHS, Macmillan, Age UK, and UK government guidance on the Mental Capacity Act.

Written by GioC, contributing writer for My Medical Choice, with several years of experience creating trusted healthcare content to support patient rights and future planning in the UK.

Disclaimer: This article is intended for informational purposes only and does not constitute medical or legal advice. Always consult a healthcare professional or solicitor for personalised guidance.

How to Protect Your Medical Rights When You Can’t Speak for Yourself