Advance Decision - Free Legal Template
Updated 17 October 2025
This Advance Decision document allows an individual to formally refuse specific medical treatments in advance, for situations where they may lose the capacity to make decisions. It outlines conditions such as persistent vegetative state, terminal illness, or severe dementia, and details the life-sustaining treatments to be refused. The document also includes provisions for a Health Care Power of Attorney and witness declarations.
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:
[a] 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.
[b] 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.
[c] 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:
[a] Is personally known to me and appears to be of sound mind and not under duress, fraud, or undue influence. [b] Has signed this Advance Decision in my presence.
Witness Name:
Address:
Date:
___________________________
Witness Signature
About this template
What is this template?
Advance Decision - Free Legal Template is a free, ready-to-use Health law template you can open, customize, and download on GitLaw. It gives you a professionally structured starting point, so you never have to draft from a blank page. The wording is plain and modern, organized into clear sections that are easy to read, edit, and adapt to your own situation before you share or sign it.
When should you use it?
Reach for this Health law template whenever you need a reliable agreement quickly and want to be sure the essentials are covered. It suits individuals, freelancers, startups, and established businesses alike. Instead of paying for a document drafted from scratch, you can start here, tailor the details to your arrangement, and have a polished draft ready in minutes. Always review the final wording against the laws that apply where you live or do business.
What's typically included?
A well-drafted Health law usually sets out the parties involved, the scope of the agreement, and each side's rights and responsibilities. Expect sections covering key terms and definitions, how long the agreement lasts, how it can be ended, and what happens if something goes wrong. This template brings those building blocks together in a sensible order, so you can focus on the specifics rather than worrying about what to include. Open it to read the full document, then sign up to edit, negotiate, and e-sign it directly in GitLaw.