Advance care planning and living wills explained

What advance care planning is

Advance care planning is a set of conversations and, sometimes, written records about your future care. It lets you set out what matters to you — where you would like to be cared for, what treatments you would want or refuse, and who you want involved — so that if illness or an accident ever left you unable to decide for yourself, those caring for you would know your wishes. It is a voluntary process; nobody has to plan ahead, and you can change your mind at any time. Planning can be as simple as talking things through with family and your GP, or it can involve formal documents. The aim is to give you a say in your care even in situations where you cannot speak, and to spare loved ones from guessing.

Living wills and advance decisions

In England and Wales, a living will is properly called an advance decision to refuse treatment. It lets you set out, in advance, specific medical treatments you would not want in particular circumstances — for example if you were permanently unable to communicate. If it is valid and applies to the situation, an advance decision is legally binding on the healthcare team. To refuse treatment that could keep you alive, it must be written down, signed and witnessed, and clearly state that it applies even if your life is at risk. You can also write down your wishes and preferences more broadly in a statement, which is not legally binding but must be taken into account. Similar arrangements exist across the UK under their own laws.

Choosing someone to speak for you

As well as, or instead of, writing down specific refusals, you can appoint someone you trust to make decisions for you if you lose the ability to do so yourself. In England and Wales this is done through a Lasting Power of Attorney for health and welfare, a legal document that must be registered before it can be used. The person you choose, your attorney, can then make care and treatment decisions in line with your wishes and best interests if you can no longer make them. There are equivalent arrangements in Scotland and Northern Ireland. Choosing someone is powerful, so it is worth picking a person who knows you well, will respect your values, and is willing to take on the role — and talking to them clearly about what you would want.

Making your wishes known

A plan only helps if the right people know about it. It is worth discussing your wishes with those close to you and with your GP or care team, and making sure any documents can be found when needed. In many parts of the UK there are ways for your key wishes to be recorded so that health and care staff, including in an emergency, can see them. A widely used tool is a personalised emergency care plan, sometimes called a ReSPECT plan, which records recommendations about the care you would want in a crisis. Keeping copies accessible, telling family and clinicians where they are, and reviewing them from time to time all help ensure your wishes are actually followed rather than sitting unseen in a drawer.

Reviewing and getting support

Your views can change as your life and health change, so advance care plans are not set in stone. It is sensible to review them now and then, especially after a change in health, and to update documents if your wishes shift. You do not have to work everything out alone: your GP, community nurses, palliative care teams and organisations that support people planning ahead can all help, and free information is available from the NHS. For legal documents such as a Lasting Power of Attorney, official guidance and forms are available, and some people choose to involve a solicitor. The overall message is reassuring: planning ahead is a gift to yourself and those you love, giving you a voice in your care and easing difficult decisions for others.