ADVANCE DECISION TO REFUSE MEDICAL TREATMENT
Important jurisdiction and formalities warning
This fictional example is a discussion aid, not medical or legal advice and not a universally valid living will. It is drafted with England and Wales in mind, where an advance decision may have strict requirements, including special signing and witnessing rules for a refusal of life-sustaining treatment. Other countries and UK jurisdictions use different concepts, forms and tests. A person should discuss this document with a clinician and an appropriate lawyer, use any prescribed form, provide copies to the GP and trusted decision-makers, and review it after a diagnosis, treatment change or move. Emergency services may not know about it unless it is accessible.
1. Person making this decision
I, Harriet Louise Morgan, born 6 November 1959, of 41 Cedar Park Road, Sheffield S11 8QT, make this advance decision on 3 May 2027 while I have capacity to understand, retain, use and communicate the decisions recorded below. My NHS number is recorded on the copy held by my GP, Dr Samuel Patel, at Cedar Park Medical Centre. I make this decision freely and after discussing its scope with Dr Patel on 21 April 2027.
2. Values and purpose
I value communication, recognition of my family and the ability to experience relationships and ordinary comfort. I do not want treatment whose only realistic result is to prolong the final phase of an irreversible condition without a reasonable prospect of recovering awareness or an ability to interact. I do want pain relief, nursing care, hydration and other comfort measures where clinically appropriate, even if a comfort medicine might incidentally shorten life when given properly.
My separate estate planning records describe my home, currently valued at approximately GBP 286,000, and savings of approximately GBP 19,400. Those figures and any future financial change do not affect this medical decision, and this document does not appoint anyone to manage my property.
3. Circumstances covered
This decision applies only if I lack capacity to consent to the treatment at the time a decision is required and a suitably qualified clinician determines that one of the following conditions exists:
- I have a progressive, irreversible neurological disease and am permanently unable to recognise close family, communicate any consistent preference or experience a meaningful interaction;
- I have suffered a catastrophic brain injury and two independent clinicians agree that recovery to conscious, communicative awareness is not reasonably expected; or
- I am in the final phase of an incurable illness and treatment would only postpone death briefly without treating the underlying condition.
This decision does not apply merely because I am elderly, physically disabled, depressed, temporarily unconscious, or unable to speak while another reliable method of communication is available.
4. Treatment refused
In the circumstances above, I refuse cardiopulmonary resuscitation, mechanical ventilation, dialysis, major surgery, clinically assisted nutrition and hydration, and antibiotics when the purpose is solely to prolong life rather than treat distress or provide a realistic opportunity for recovery. I also refuse admission to an intensive-care unit solely for life prolongation. I do not refuse ordinary nursing, oxygen for breathlessness, suction, repositioning, mouth care, treatment of pain, anxiety or nausea, or medication needed to maintain dignity and comfort.
This wording is intended to describe treatment categories, but a clinician must interpret it in the context of the actual condition and law. If a refused treatment is immediately required for a reversible condition and a clinician reasonably believes the condition is outside the circumstances I described, I ask that my refusal not be applied automatically and that my representative be contacted urgently.
5. Specific life-sustaining statement
I specifically refuse life-sustaining treatment in the circumstances set out in section 3, even if my death is expected without it. I understand that refusing such treatment may cause my death sooner. I request comfort-focused care and respectful communication with my family. I understand that a clinician may need to assess whether this decision is valid and applicable at the time.
6. People to consult
My first person to consult is my partner, David Alan Morgan, of 41 Cedar Park Road, Sheffield S11 8QT, telephone 0114 555 7012. My second person to consult is my daughter, Emily Rose Morgan, of 9 Park View, Leeds LS6 2DW, telephone 0113 555 4480. They are asked to explain my wishes and locate the latest copy, but this document does not appoint either person as an attorney or give either person authority that requires a separate legal instrument.
7. Review and withdrawal
I intend to review this decision every two years and after a significant diagnosis, treatment change, hospital admission or move. I may withdraw or amend it while I have capacity by telling a clinician, my family or another appropriate person, and by destroying or replacing copies where practical. The latest valid decision should be identified by its date. If a conflict exists between this document and a later valid communication, the later decision should be considered under applicable law.
8. Distribution and governing law
I ask Dr Samuel Patel to place a copy in my medical record and give copies to Sheffield Teaching Hospitals NHS Foundation Trust if I am referred there. This example is intended to be considered under the law applicable in England and Wales, but mandatory law, clinical duties and a different place of treatment may affect it. No person should assume that this document alone satisfies every statutory formality.
Statement and signatures
I have read this decision, understand its consequences as explained to me, and make it voluntarily.
Harriet Louise Morgan
Signature: ____________________ Date: 3 May 2027
Witness: Priya Shah, 22 Brook Street, Sheffield S10 2LF
Witness signature: ____________________ Date: 3 May 2027
Clinician discussion record: Dr Samuel Patel, Cedar Park Medical Centre, 21 April 2027
Clinician signature: ____________________ Date: 3 May 2027
The required statutory wording, signing and witnessing for any refusal of life-sustaining treatment must be checked before this example is relied upon.