"Living will" is the everyday name; the law calls it an advance decision to refuse treatment. It is the mechanism, under the Mental Capacity Act 2005, by which you can refuse specific medical treatment now, in writing, so that the refusal still speaks for you later when you cannot. Properly made, it is not guidance for doctors to weigh. It binds them as if you were refusing in the room.
What an advance decision can and cannot do
It can refuse treatment: ventilation, resuscitation, antibiotics in defined circumstances, blood transfusion, anything you name, in the situations you describe. It cannot demand treatment; doctors decide what is clinically appropriate to offer. It cannot refuse basic care like warmth, shelter and offers of food and drink by mouth. And it has nothing to do with assisted dying, which remains a separate legal question entirely. An advance decision only ever declines medical interventions.
When it is binding
Three conditions: you had capacity when you made it, it is valid (not withdrawn, not contradicted by your later behaviour, not overridden by a later document), and it is applicable, meaning the situation doctors face is the one you described. Precision matters more than eloquence: a decision that names circumstances clearly is followed; a vague one becomes something doctors must interpret.
Refusals of life-sustaining treatment carry extra formalities: the decision must be in writing, signed and witnessed, and must state expressly that it applies even if your life is at risk. Miss those and the document drops from binding to merely influential.
Advance decision or health and welfare LPA?
The two instruments solve the same problem in different styles. An advance decision is you deciding now: fixed answers to situations you can foresee. A health and welfare LPA is you choosing a person: someone who will weigh situations you cannot foresee, with legal authority to answer for you, including over life-sustaining treatment if you grant it.
They can coexist, and the order matters. If you make a health and welfare LPA after your advance decision, and it gives your attorneys authority over the same treatment, the LPA wins and your attorneys decide. An advance decision made after the LPA takes priority on the specific treatments it covers. The clean approach is to make them together, tell your attorneys the advance decision exists, and mean the two documents to agree.
Making one that works
- Be specific about both the treatment refused and the circumstances: "if I have advanced dementia and cannot recognise my family, I refuse..." does real work; "no heroic measures" does none
- For life-sustaining refusals: written, signed, witnessed, with the "even if my life is at risk" statement
- Give copies to your GP for your medical record, your attorneys and your family; a document nobody can find at 3am binds no one in practice
- Review it after every significant diagnosis and every few years; a decision consistent with recent conversations carries more weight, and treatments change
- Talk about it: the document works best as the written record of wishes your family already knows
Part of the same conversation
An advance decision, an LPA and a will are three answers to one question: who speaks for you when you cannot speak. Willful handles the LPA side for £99, solicitor-reviewed, and the same interview approach means the hard questions are asked properly rather than skipped. If you are recording an advance decision too, tell your attorneys where it lives; the documents should work as a team.