Use this template, created by Alzheimer's Society, to write an advance decision to refuse treatment. 

If you have dementia, you may wish to make an advance statement to express your wishes, feelings and values. Find out why you might make one and how they are different to advance decisions.

As well as making an advance decision, you might have made or be thinking about making a Lasting power of attorney (LPA) for health and welfare. 

If you change your mind about your advance decision, you can review and make changes to this document.

Let people know that you have an advance decision and where to find the document. You should make copies of it for people close to you. 

Read our advice on how to make an advance decision if you have dementia, who you should talk to about it, and what to include when writing it.

Advance decisions can be used to refuse treatment when you no longer have capacity. Find out if they are legally binding, why you might make one, what treatments you can refuse, and what an advance decision cannot do.

When you have dementia, planning ahead may include writing an advance decision or advance statement. You can use these to make decisions about care and treatment in the future.