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Making your Advance Decision

There is no ‘standard form’ for making an Advance Decision (AD) – because everyone’s circumstances, and their wishes for the future, are different.  However, most people find it difficult to start from scratch, and it can really help to see the sorts of things other people have written.

Below are 4 examples of ADs – Ann, Brian, Chris and Dawn - based on our experience of helping people write ADs, and the kinds of concerns they most commonly raise.  For each, we have included their legally-binding AD, and a short ‘values statement’ in which they explain their decisions.

We suggest you start with the person whose circumstances are closest to yours, and see if an AD based on theirs would represent your wishes.  Each person’s AD links to a form you can use to make your own AD, with space for your own personal ‘values statement’.  You can change the details to suit you, or ‘mix and match’ from the different examples.


Ann is a physically active 25-year-old, with no major health problems.  She is concerned about what would happen if she suffered serious brain damage in a sporting accident.

Read Ann’s Advance Decision

Make an Advance Decision similar to Ann's (Form A)


Brian is 50 and generally healthy, although he has Type 1 diabetes and is prone to bouts of depression.  His parents both died after many years in long-term care homes and Brian wants to try and avoid this fate.

Read Brian’s Advance Decision

Make an Advance Decision similar to Brian’s (Form B)

Mental capacity statement similar to Brian's


Chris is in her late 60s and has a range of health problems which mean she  experiences substantial pain on a daily basis.  She is also a breast cancer survivor.  She does not want life-prolonging treatments in the future.  She has strong religious beliefs.

Read Chris’s Advance Decision

Make an Advance Decision similar to Chris’s (Form C)


Dawn is 82 and has just been diagnosed with Alzheimer’s disease.  She also has heart and circulatory problems.  She hopes to avoid years of decline and eventual death with late-stage dementia, preferring to die sooner.  Her adult daughter is very distressed by this.

Read Dawn’s Advance Decision

Make an Advance Decision similar to Dawn’s (Form D)'

Mental capacity statement similar to Dawn's

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