Advance and future decision-making

Future-care planning allows people to record what matters to them before illness makes communication or decision-making more difficult. It can improve continuity across settings, help families understand preferences and support clinicians when urgent decisions arise.

Different documents have different legal effects. The safest approach is to identify what the document is, which jurisdiction applies, whether it is current and relevant, and what authority it carries.

In England and Wales the Mental Capacity Act provides for advance decisions to refuse treatment. Formal requirements become particularly important where life-sustaining treatment is refused. A document should not be treated as binding without checking validity and applicability to the exact treatment and circumstances.

Other UK jurisdictions use different legal routes and terminology. Do not assume that an “advance directive” has identical status everywhere.

A written statement of wishes, values or preferences can be highly relevant even when it is not a legally binding refusal. It may explain what outcomes the person would find unacceptable, who they want involved, where they prefer care or how they balance longevity and independence.

These statements inform patient-centred reasoning; they should not be mislabelled as binding treatment refusals if that is not their legal status.

Emergency or future-care plans such as ReSPECT are clinical recommendation processes. They can be extremely useful, but they are not the same thing as a legally binding advance refusal. A plan may need review when the person’s health, goals or treatment options change.

When a future decision-making document is found, ask: does it relate to this person, is it valid under the relevant law, has it been withdrawn or superseded, does it cover this treatment, and do the current circumstances match those contemplated?

In an emergency, information may be incomplete. Document what was available, what checks were possible and why a particular course was followed.

Where the person currently has capacity, their present decision takes priority over a prior statement made for future incapacity. Where they lack capacity, current behaviour, preferences and distress can still be relevant alongside the prior plan.

Plans should be accessible to the teams likely to need them and reviewed when circumstances change, subject to confidentiality and information-governance requirements.

Use the search box in this module to jump to these terms and related concepts.

• advance decision
• advance refusal
• advance directive
• advance statement
• future care planning
• validity
• applicability
• LPA
• welfare attorney

Produce a checklist-style note documenting what future-planning document was reviewed, how its validity/applicability was considered and what current information was taken into account.

Use current official sources for further reading. Links open the issuing organisation.

• MC-EW-01 — Mental Capacity Act 2005
• MC-S-04 — Adults with incapacity: continuing and welfare attorneys - code of practice
• EOL-NI-01 — Advance Care Planning: For Now and For The Future - Northern Ireland
• EOL-W-04 — Welsh Government - Advance care planning statement
• EOL-UK-04 — Resuscitation Council UK - ReSPECT
• EOL-UK-05 — Resuscitation Council UK - FAQs: decision making and CPR

Sources checked through 17 September 2026. High-volatility legal topics must be rechecked before patient-specific decisions.