Advance Statements

​An Advance Statement (sometimes called a ”Statement of Wishes) allows the person you care for to record their wishes, feelings, beliefs, lifestyle choices, and values in case they become unwell and need care and treatment. An advance statement can be about anything that is important to them in relation to their future health and wellbeing.

For example, an advance statement could contain their preferences for where they wish to receive care, their spiritual or religious needs, or anything which is important to their identity that will inform any choices made by you or by health or social care professionals when they cannot make decisions for themselves.

An Advance Statement must be taken into account by anyone making a best interest decision for the person.

An Advance Statement is not legally binding; however, there has to be a good reason for health and care staff to ignore the person’s wishes. There could be circumstances where it is not safe to follow an aspect or aspects of the care plan and this should be fully explained to you.

1. Talk to the person about their wishes. Go to What does planning ahead involve? to help you.
2. Make sure their wishes are written down. An Advance Statement can be included in an Advance Care Plan. See Advance Statement templates in different languages.

• The person you care for is legally entitled to say if there are particular treatments they would not want to have. This is also called an Advance Decision to Refuse Treatment (also referred to as “ADRT” or a “Living Will”). 
• The person you care for has to have the mental capacity to make their own decision about what treatment they are refusing otherwise it will not be legally valid.
• The person you care for has to state the specific treatment they do not want and in what circumstances the refusal will apply.
• If the person you care for chooses not to have a treatment that will keep them alive (known in law as ‘life sustaining treatment’) they have to be very specific about the circumstances, put this in writing, sign it and have it signed by a witness. An example of this might be the refusal of a mechanical ventilator or a blood transfusion. 
• The person you care for cannot refuse care to make them comfortable, nor can they request help to bring about the end of their life.
• It does not cost anything to make an Advance Decision to Refuse Treatment and the person you care for does not need a solicitor to help them make one.
• A doctor or nurse must follow an Advance Decision to Refuse Treatment as it is legally binding under the Mental Capacity Act 2005. However, it must be valid. In other words, it must meet all the requirements outlined above AND apply to the person’s situation at that time.

Things to think about

1. Discuss this option with the person you care for, and also encourage them to talk to a doctor or nurse who knows about their condition, so they can make a fully informed decision and understand what it means if they choose not to have a particular treatment.
2. You should find out whether the person you care for has previously made a Lasting Power of Attorney (LPA) for Health and Welfare. Although you can have both an ADRT and LPA, one may override the other in relation to certain decisions.  
3. Encourage the person you care for to complete a template form to make sure an advance decision is legally compliant. You and they can then hold a copy and share it with health and social care professionals as well as other family and friends. In particular, where there is an LPA for Health and Welfare and an ADRT is in place the person should make sure to give the attorney appointed under the LPA a copy of the ADRT.
4. See how to write an ADRT together with a helpful template.