What is an Advance Decision to Refuse Treatment?

Should you become ill and be unable to communicate your wishes, it can be helpful to consider creating a document known as an Advance Decision to Refuse Treatment or ADRT. An ADRT, sometimes known as a Living Will or simply an Advance Decision, is a legally binding document. It helps to guide professionals on the types of treatments that you may wish to refuse or withdraw from in specific circumstances. An ADRT will ensure that your wishes are carried out should you become incapacitated.

Who Can Make an Advance Decision?

Any adult can make an ADRT. However, certain legal criteria must be met. You must:

• Be 18 years of age or over
• Have the mental capacity to make the decision

What Treatments Can I Refuse?

Although it is not necessary to write your ADRT in medical language, it still needs to be specific enough to be followed. A blanket instruction that you don’t want medical intervention is insufficient.

In order for your ADRT to be an effective document, it is essential that you discuss your condition with your doctor. They will be in a position to identify the possible outcomes and treatments that your illness is likely to require.

This discussion will help inform the decisions that you make regarding your care and treatment pathway. It will allow you to be specific about any potential interventions that may be made on your behalf. You will then be in a position to accept or decline all or part of the treatments that are suggested.

A discussion with your doctor will inform what information you need to include in your Advance Decision when choosing to decline treatments and when your decisions should apply.

You should be aware that an ADRT cannot be used to ask for anything illegal such as assistance to end your life or to refuse to be offered food and drink by mouth or refuse care that keeps you clean and comfortable. This is classed as basic care and your healthcare professionals have a duty to provide this.

The below is a (fictional) example of how ARDT may be used in real life.

Mr S was told that he had an untreatable, progressive and terminal disease. It would lead to the slow closing down of his body. He discussed the likely prognosis for his condition with his doctor and decided that, when the time came, he would accept assistance with his breathing. However, in the event of him needing a ventilator that would take over his breathing, he wished to refuse this intervention. Mr S was able to specify his requirements in his ADRT.

How Do I Ensure my ADRT is Legally Binding?

As well as the criteria mentioned above the document must state specifically that the Advance Decision applies even if your life is at risk as a result of refusing treatment.

Importantly, and to ensure legal validity, the document must also be signed, witnessed and dated.

How Can I Make Sure People Know About My Decision?

Once you have created your Advance Decision, it is important that any relevant people know about it. This should include your loved ones, your GP and your local hospital. Sending copies of your Advance Decision will help ensure that your wishes are fulfilled when the need arises.

The contents of your ADRT may be difficult to contemplate whilst you are relatively well. However, once completed, it will offer you assurance and peace of mind. Furthermore, it may well assist your loved ones and medical professionals to carry out their own roles to the best of their ability – all in the knowledge that they are supporting you by fulfilling your expressed wishes.

A valid ADRT is legally binding in England and Wales under the Mental Capacity Act 2005. This means that if a healthcare professional knows you have made a valid and applicable Advance Decision, they must follow it.

Find out more about Advance Decisions here.

This article was written in collaboration with AM Davies Solicitors.