How to Write an Advance Directive UK

Start with What You Are Refusing

An ADRT must name the specific treatments you refuse and the specific clinical circumstances under which those refusals apply. This is the core of the document, and it is where most drafting errors happen.

Generic phrases like "no extraordinary measures," "no life support if there is no hope," or "no treatment if I cannot enjoy life" are legally weak. They give clinicians enough interpretive room to argue the document does not clearly apply to the patient's current presentation — and when there is doubt, the default is treatment.

Effective drafting uses clinical terminology:

• "I refuse invasive mechanical ventilation via endotracheal intubation" — not "I refuse life support"
• "I refuse clinically assisted nutrition and hydration delivered via nasogastric tube, PEG tube, or intravenous line" — not "I refuse tube feeding"
• "I refuse cardiopulmonary resuscitation" — not "I refuse resuscitation"
• "I refuse intravenous antibiotic therapy for the purpose of prolonging life" — not "I refuse antibiotics"

Define the Clinical Triggers

Each treatment refusal needs a clinical trigger — the condition under which the refusal activates. Again, specificity matters.

Instead of "if I have severe dementia," use clear, clinically assessable functional criteria: "if I have late-stage, irreversible dementia, assessed against clear functional criteria."

Instead of "if I am terminally ill with no chance of recovery," define the clinical criteria: "if I am in a persistent vegetative state, as assessed by the treating team."

The more precisely you define your triggers, the harder it is for a clinician to argue the ADRT does not apply.

The "Life at Risk" Clause

If any of your treatment refusals involve life-sustaining treatment, the ADRT must include a written statement confirming: "I understand that this advance decision applies even if my life is at risk as a result."

This clause must be present in the document. Without it, refusals of life-sustaining treatment are not legally binding.

The Execution Steps

1. Write the document. Include your full name, date of birth, address, and a clear statement that this is an Advance Decision to Refuse Treatment under the Mental Capacity Act 2005.

2. List each treatment refusal with its clinical trigger. One section per refusal, using the precise language described above.

3. Add the life-at-risk clause if any refusal covers life-sustaining treatment.

4. Sign and date the document. If you cannot sign, someone else can sign at your direction in your presence.

5. Have a witness sign and date. This is legally required only for refusals of life-sustaining treatment, but recommended for all refusals to strengthen the document against future challenges.

6. Discuss with your GP. Book an appointment, walk through the document, and ask the GP to confirm on your medical record that you have made an ADRT. This is not legally required, but it creates an independent professional record that you had capacity when you made the decision — which is valuable if the document is later challenged.

What Not to Include

Do not use the ADRT to request specific treatments. An ADRT can only refuse treatments; it cannot demand them.

Do not try to refuse "basic care" — warmth, shelter, hygiene, and the offer of oral food and water. The Mental Capacity Act explicitly excludes these from advance refusals.

Do not include instructions about your funeral, organ donation, or financial affairs. These belong in other documents (your will, the NHS Organ Donor Register, your Property and Financial Affairs LPA).

The England ADRT Guide includes a complete clinical phrasing registry with ready-to-use drafting templates for each major treatment refusal, a GP consultation preparation sheet, and the full witnessing protocol to ensure your ADRT is legally valid and clinically precise.

See more England guides →