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Advance decision
Advance directive, living will
An advance decision is a refusal of a specific treatment, made by an adult with capacity, to apply if they later lose it.
Summary
- A valid and applicable advance decision is legally binding in England and Wales under the Mental Capacity Act 2005.
- A refusal of life sustaining treatment must be in writing, signed and witnessed, and must say that it applies even if life is at risk.
- It can refuse a treatment but cannot demand one.
- It is also known as an advance directive or a living will.
In practice
- A person can withdraw an advance decision at any time while they have capacity. Section 25 of the Mental Capacity Act 2005 says a withdrawn decision is not valid.
- A later lasting power of attorney can override it. Under the same section, the decision is not valid if the person later gave an attorney the power to consent to or refuse the same treatment.
In Hong Kong
- Hong Kong's law is the Advance Decision on Life Sustaining Treatment Ordinance, which came into effect on 31 July 2026. It calls the document an advance medical directive.
- Any adult who is mentally capable of deciding on life sustaining treatment can make one, and the law does not stop a healthy person from doing so. Two witnesses are needed, one of them a doctor registered in Hong Kong.
- It applies only once the person has lost capacity and a condition named in it is met: terminal illness, a persistent vegetative state or irreversible coma, or another end stage condition that cannot be reversed.
Interview questions
- An unconscious patient arrives with a written advance decision refusing ventilation. What do you do?
- What is the difference between an advance decision and an advance statement?
- Should a decision made years ago bind doctors today?
Sources
- legislation.gov.uklegislation.gov.uk/…/25
- Hong Kong Governmentinfo.gov.hk/…/P2026073100286p.htm
- Health Bureau, Hong Konghealthbureau.gov.hk/…/index.html
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