End-of-life care planning (Advance care planning)
A conversation, written down, where you set out your wishes for your care and treatment in case there is a time later when you cannot speak for yourself.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Advance care planning records your wishes for future care in case you later cannot speak for yourself; it is about your choices and your voice.
- It does not limit the care you can have now, and you can change or cancel any part of it at any time.
- Some parts can be legally binding (such as an advance decision to refuse treatment or a lasting power of attorney); others guide your team without being binding.
- Make sure your plan is written down, shared with the right people and easy to find when it is needed.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Your voice is heard even if you later cannot speak for yourself
Someone who lacks the mental capacity to make a particular decision cannot make a valid advance decision about it, though their wishes should still be...
You talk through what matters to you, with time to think, ask questions and involve family if you wish. Nothing is rushed.
A clear record of wishes, written down and shared with permission.
You talk through what matters to you, with time to think, ask questions and involve family if you wish. Nothing is...
Your wishes are written into the right documents. You may feel relief, but it is also normal to feel emotional or...
The plan is shared, with your permission, so the right services can find it. You keep your own copy.
You can revisit and change the plan whenever you wish, especially if your health or your views change.
What is end-of-life care planning?
End-of-life care planning, often called advance care planning, is a way of thinking about and writing down what matters to you for your future care. It is for a time, which may never come, when you might be too unwell to make decisions or to say what you want.
It is a conversation as much as a form. You might talk about where you would like to be cared for, what treatments you would or would not want, who should speak for you, and what is most important to you — for example comfort, family, faith or staying at home. A clinician, nurse or trained professional can guide the conversation and help record it.
Planning ahead is empowering, not a sign of giving up. It is about your choices and your voice. You can change your mind at any time, and having a plan does not stop you receiving any treatment you want now. It simply helps the people caring for you follow your wishes if you cannot tell them yourself.
In England and Wales, some choices can be made legally binding, such as an advance decision to refuse a specific treatment, or naming someone through a lasting power of attorney. Other parts, like an advance statement of your wishes, guide the people caring for you without being legally binding. The rules differ across the UK, and a clinician can explain what applies where you live.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Advance statement of wishes
A written or spoken record of what matters to you: where you would like to be cared for, your routines, beliefs and preferences. It guides your team but is not legally...
Advance decision to refuse treatment (ADRT)
A written decision to refuse a specific treatment in particular circumstances. In England and Wales this is legally binding under the Mental Capacity Act if valid and...
Lasting power of attorney
Naming a trusted person to make decisions for you if you lose the ability to do so. A health and welfare attorney can make care and treatment decisions on your behalf.
ReSPECT or emergency care plan
A summary that helps clinicians make quick decisions about emergency care and treatment if you cannot take part, including whether attempts at resuscitation would be wanted.
Preparing for your appointment
- Think about what matters most to you: comfort, independence, family, faith, place of care.
- Consider who you would want to speak for you if you could not speak for yourself.
- Gather any existing documents, such as a previous advance decision or power of attorney.
- Note any treatments you feel strongly about wanting or not wanting, and any past experiences shaping this.
- Think about whether you would like a family member, friend or carer with you for the conversation.
- Write down questions, including how your plan will be recorded and shared.
- Remember you do not have to decide everything at once; planning can happen over several conversations.
What happens
Planning usually happens through one or more unhurried conversations, with your GP, a nurse, a palliative care professional or another trained person. There is no examination or procedure; it is a discussion about you and your wishes.
The person guiding you will explain the different parts of planning, answer questions, and help you put your thoughts into words. They will check what you understand about your situation, but at a pace that feels right for you. You can pause, take time, or involve family or someone you trust.
Your wishes are then written down in the right format, whether that is an advance statement, an advance decision, an emergency care plan or notes towards a power of attorney. You may need to sign certain documents, and an advance decision to refuse life-sustaining treatment has specific signing and witnessing rules.
Finally, the plan is shared, with your permission, so the right people can see it when needed, for example your GP, out-of-hours services, the ambulance service and the hospital. You keep a copy, and you can review or change it whenever you wish.
Is this appointment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Someone who lacks the mental capacity to make a particular decision cannot make a valid advance decision about it, though their wishes should still be sought and a best-interests process used.
- Planning is not a substitute for urgent care when someone has pressing symptoms or is in crisis now.
- An advance decision is not the right tool for choices that need a current, in-the-moment discussion with a clinician.
Delay or rearrange if…
- The person is too unwell or distressed to take part meaningfully at that moment.
- There is an immediate crisis or symptom that needs attention first.
- Key information is missing, such as a clear understanding of the current situation.
- The person wants more time, or to involve family or an interpreter, before deciding.
Alternatives to discuss
- Talking informally with family about your wishes, even without formal documents.
- Naming a lasting power of attorney so a trusted person can decide for you.
- Recording wishes through your GP or palliative care team rather than privately.
- Seeking legal advice for the binding parts, such as an advance decision or power of attorney.
- Revisiting planning later if now does not feel like the right time.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Your voice is heard even if you later cannot speak for yourself
- Greater sense of control and peace of mind
- Eases pressure on family, who do not have to guess your wishes
- Helps avoid unwanted treatments or hospital admissions you would not have chosen
- Makes it more likely you are cared for where you wish to be
- Gives your whole care team a shared understanding of what matters to you
Risks & complications
- The conversations can be emotional and tiring
- Talking about the future can feel daunting at first
- You may not feel ready to decide everything in one go
- Family members may have different views that need gentle discussion
- A plan that is not shared properly may not be found when it is needed
- Wishes written too vaguely can be hard for clinicians to follow
- An advance decision may not apply if the situation differs from what was written
- Plans can become out of date if circumstances change and they are not reviewed
- Disagreements about a plan occasionally need senior clinical or legal input to resolve
- Very rarely, the legal validity of a document is questioned
The main pitfalls are not medical but practical: a plan that is too vague, out of date, or not shared with the right people may not work when it matters. Take time, be as clear as you can, ask who will be able to see it, and review it if your situation changes. There is no obligation to decide everything at once.
Published figures to discuss
End-of-life care planning is a conversation and a set of written choices, not a clinical procedure, so there are no meaningful complication or success rates to quote. The factors that decide whether a plan works are practical: how clearly wishes are written, whether the plan is shared, and whether it is kept up to date.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Wishes not documented before crisis | Common | Advance care planning works best before the person is too unwell to discuss priorities. | Guide sourcesClinical context |
| DNACPR misunderstood | Common communication risk | DNACPR relates to CPR only; it does not mean no treatment, no comfort care or no hospital care unless otherwise agreed. | NHS — Planning ahead for end of life carenhs.ukSource-linked context |
| Capacity or best-interests process missed | Legal/process risk | If the person lacks capacity, decisions should follow the Mental Capacity Act and involve those important to them. | NHS — Planning ahead for end of life carenhs.ukSource-linked context |
| Family conflict at the end of life | Common when plans are unclear | Clear documentation and communication reduce distress and unwanted transfers. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery, because this is a conversation and a written plan rather than a procedure. Afterwards, you leave with your wishes recorded and a clearer sense of how your care will follow them.
- Feeling emotional or tired after the conversation
- A sense of relief at having things written down
- Wanting time to reflect before finalising some choices
- Coming back with more questions later
- Needing more than one conversation to cover everything
Aftercare
- Keep your own copy of the plan somewhere easy to find.
- Tell trusted family or friends that the plan exists and where it is.
- Check that your GP and other key services have a copy, with your permission.
- Review the plan if your health changes, you change your mind, or your circumstances change.
- Make sure any named attorney or spokesperson knows their role and your wishes.
- Ask how the plan will be accessed in an emergency, including out of hours.
- Keep contact details for your GP or palliative care team with the plan.
- Your own copy of the plan stored somewhere safe and findable
- Family or trusted people told it exists
- GP and key services sent a copy with your permission
- Any legal documents correctly signed and witnessed
- A named spokesperson or attorney who understands your wishes
- A note of how the plan is accessed in an emergency
⚠ Get urgent help if…
- Feeling overwhelmed, very low or hopeless after these conversations — tell your team so support can be offered
- Thoughts of harming yourself — seek help straight away from your GP, or the Samaritans (call 116 123, day or night). For urgent advice you can also call NHS 111 in England, Scotland or Wales; in Northern Ireland, contact your GP out-of-hours service or your HSC Trust's Phone First line instead. If life is at immediate risk, call 999 or go to A&E
- New or worsening symptoms that need attention now rather than future planning
- Confusion about whether a document is legally valid — ask your clinician or seek advice
- Realising your plan is out of date or has not been shared — raise this with your GP or team
- Family conflict about your wishes that you cannot resolve — ask your team for help
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good outcome is a clear, up-to-date plan that genuinely reflects what matters to you, written down and shared so the people caring for you can follow it. It can bring real peace of mind to you and to those close to you.
A plan cannot predict every situation, and it does not force a particular outcome; clinicians still use their judgement alongside your wishes, especially where a situation differs from what you anticipated. It is a guide that puts your voice at the centre, not a guarantee that everything will go exactly as imagined.
A plan is not a one-off. Your wishes can change as your health, relationships or outlook change, and a plan made some time ago may no longer fit. It is sensible to revisit it from time to time, and especially after any major change in your health, so it always reflects what you want now.
Related tests, treatments or support
End-of-life care planning often sits alongside other support, such as a referral to a palliative care team, hospice care, home palliative support, and psychological and family support. It also links with practical and legal planning, like making a will or sorting out finances, which a solicitor or advice service can help with.
Follow-up & long-term care
Your GP, nurse or palliative care team can revisit the plan with you whenever you wish, and will often offer to review it as your situation changes. They can also make onward referrals, for example to a hospice or for emotional support, and ensure the plan stays shared with the right services.
- Review the plan after any significant change in your health or wishes.
- Keep shared copies up to date if you make changes.
- Make sure any new clinicians involved in your care know the plan exists.
- Check that legal documents remain valid and reflect your current wishes.
Repeat, follow-on and what comes next
- Plans are meant to be revisited and updated; changing your mind is normal and expected.
- A plan made some time ago may no longer fit and should be reviewed after any major change.
- Wishes written too vaguely may need to be revisited so clinicians can follow them clearly.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear record of wishes, written down and shared with permission.
- A named contact to revisit the plan whenever needed.
- Joined-up sharing with the GP, out-of-hours and emergency services.
- An offer of emotional support if the conversation has been hard.
- A standing invitation to review and update the plan as things change.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether you use NHS and hospice services (usually free) or a private clinician
- The length and number of planning conversations
- Whether legal documents are involved, such as a lasting power of attorney or will
- Solicitor or registration fees for legal documents, separate from the care conversation
- Any private nursing or care coordination supporting the plan
- Follow-up reviews if arranged privately
- Whether the planning conversation itself is being charged for, and by whom
- What is included: the conversation, written documents and sharing the plan
- Any separate legal fees for documents such as a power of attorney
- How follow-up or review conversations are arranged and charged
- Whether NHS or hospice options that are free have been explained
- Who to contact afterwards if your wishes change
On the NHS? Advance care planning is a standard, free part of NHS, GP and hospice care; legal documents such as a lasting power of attorney may carry separate fees if you use a solicitor.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Recording wishes when the person does not fully understand their situation or the options.
- Family or professionals steering the decision rather than the person leading it.
- Writing a plan that is too vague to act on, or that is never shared with the right people.
- Not explaining which parts are legally binding and which are guidance.
- Not making clear that the person can change their mind at any time.
Marketing red flags
- Charging high fees for a conversation that is normally free on the NHS or through a hospice.
- Selling a document as a complete solution without ensuring it is shared and findable.
- Pressuring someone to decide quickly rather than at their own pace.
- Implying a plan guarantees a particular outcome, which it cannot.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Which parts of a plan are legally binding where I live, and which are guidance?
- How will my plan be recorded and shared so it can be found in an emergency?
- Who can I name to speak for me, and how do I set that up?
- How do I make sure my wishes about resuscitation and emergency treatment are clear?
- How and when can I review or change my plan?
- Can you refer me for extra support, such as a hospice or counselling, as part of planning?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my appointment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this appointment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Does making a plan mean I am giving up?
Can I change my mind later?
Is an advance decision legally binding?
Who should I share my plan with?
Is this available on the NHS?
Do I have to decide everything at once?
Find a verified specialist for end-of-life care planning
Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.
No verified consultants list this procedure yet — browse the full directory.
How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Planning ahead for end of life care Marie Curie — Advance care planning NHS — Advance decision to refuse treatment (living will) Resuscitation Council UK — ReSPECT process GOV.UK — Make, register or end a lasting power of attorney nidirect — Urgent and emergency care services nidirect — GP out-of-hours service
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Hospice referral and care · Home palliative care support · Psychological and family support · Anticipatory ('just in case') medicines · Palliative medicine consultation