Advance Decision by EasyLegalDocs
This document is an Advance Decision, also known as a Living Will, which allows an individual to refuse specific medical treatments in advance. It ensures that their wishes regarding life-sustaining treatments, terminal illness care, and severe cognitive impairment are respected if they lose the capacity to make decisions in the future. It also includes provisions for a Health Care Power of Attorney and legal protection for healthcare providers.
ADVANCE DECISION
I, [name], born on [date of birth], residing at [address], being of sound mind, hereby make this Advance Decision to refuse medical treatment.
Statement of Intent
This document is my Advance Decision to refuse medical treatment. It represents my wishes and values and should be followed if I lack the capacity to make treatment decisions at any time in the future.
Declaration of Capacity
I confirm that I am at least 18 years old and I make this Advance Decision voluntarily, without any undue influence, and I understand the nature and consequences of refusing medical treatment.
Specific Refusals of Treatment
I refuse the following treatments under the circumstances described below:
If I am in a persistent vegetative state or in a condition of irreversible unconsciousness, I refuse:
Life-sustaining treatments including mechanical ventilation, resuscitation, and artificial nutrition and hydration.
If I have a terminal illness where death is imminent, I refuse:
Treatments that may prolong life but do not provide comfort or relieve pain, including blood transfusions, dialysis, and use of breathing machines.
In the event of severe dementia or irreversible cognitive impairment, I refuse:
Antibiotics for life-threatening infections and other treatments that may prolong life but do not improve quality of life.
Power of Attorney
If I have appointed a Health Care Power of Attorney (or similar), their authority is to interpret and enforce this Advance Decision.
Validity and Revocation
This Advance Decision will remain effective indefinitely unless I revoke it in a written document.
Legal Protection for Health Care Providers
I understand that no healthcare provider who respects my wishes as set out in this Advance Decision will be liable for my death.
Signatures
Signed by [name]
Date: ___________________________
____________________________
Signature
Witness Declaration I declare that the person signing this Advance Decision:
Is personally known to me and appears to be of sound mind and not under duress, fraud, or undue influence.
Has signed this Advance Decision in my presence.
Witness Name: ___________________________
Address: ___________________________
Date: ___________________________
___________________________
Witness Signature
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This version is drafted for England & Wales. Scotland and Northern Ireland differ on some points — for example notice periods and tribunal procedure. Tell GitLaw where you hire and it adjusts the draft.
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