Advance Decision to Refuse Treatment

Advance Decision Form UK

An Advance Decision to Refuse Treatment (ADRT), sometimes informally called a living will, is a legally recognised document in the United Kingdom. It allows you to specify medical treatments you wish to refuse in the future, should you lose the mental capacity to communicate your own decisions at that time. This document ensures your personal wishes regarding healthcare are respected, providing clarity for medical professionals and your loved ones during difficult situations.

What is an Advance Decision to Refuse Treatment in the UK?

An Advance Decision is a formal statement made under the Mental Capacity Act 2005. It specifically relates to the refusal of particular medical treatments at a point in the future when you may lack the capacity to consent to or refuse that treatment. It is not about requesting a specific treatment, but about outlining what you do not want. This document is legally binding on healthcare professionals, provided it meets certain conditions set out in law.

It is distinct from a general statement of wishes and feelings or an Advance Statement, which guides care but is not legally binding in the same way. The key purpose of an ADRT is to give you control over your future medical care, aligning it with your personal beliefs, values, and quality-of-life considerations.

Key Elements to Include in Your Advance Decision Form

For an Advance Decision to be valid and applicable, it must contain specific information. A well-drafted form should guide you through including all necessary elements clearly and comprehensively.

• Your Personal Details: Full name, date of birth, and address.
• A Clear Statement: A declaration that the document is intended to be an Advance Decision under the Mental Capacity Act 2005.
• Specific Refusals: A detailed list of the treatments you wish to refuse. Vague statements are not valid; you must be as specific as possible regarding the treatment and the circumstances (e.g., "If I am diagnosed with a condition where recovery is medically impossible, I refuse cardiopulmonary resuscitation (CPR)").
• The Circumstances: The specific situations or conditions in which the refusals should apply (e.g., "if I have a permanent vegetative state with no chance of recovery," "if I have advanced dementia and develop pneumonia").
• Date and Signature: The document must be signed and dated. If you are unable to sign, it can be signed on your behalf in your presence and at your direction.
• Witness Signature: A witness should also sign to confirm they saw you sign the document (or sign it on your behalf). For refusals of life-sustaining treatment, the witness requirements are particularly important.

How to Fill Out an Advance Decision to Refuse Treatment Form

Using a structured document simplifies the process. Here is a step-by-step guide to completing such a form effectively.

1. Reflect on Your Values: Consider what quality of life means to you and under what circumstances you would find certain treatments unacceptable.
2. Be Specific with Refusals: Use the form's sections to list each treatment you wish to refuse. Avoid broad terms like "aggressive treatment." Instead, name the procedure or intervention and the specific conditions under which you would refuse it.
3. Define the Scenarios: In the provided clauses, describe the medical condition or state you are anticipating. Precision is crucial for correct application of your decision.
4. Discuss with Your GP: It is highly advisable to talk through your decisions with your doctor or a healthcare professional. They can ensure you understand the implications of refusing specific treatments and help clarify the wording.
5. Complete the Declaration: Fill in your personal details, sign, and date the document in the presence of a witness. The witness should also sign, confirming your signature.
6. Distribute Copies: Provide copies to your GP, your family, and anyone you have appointed as a Lasting Power of Attorney for Health and Welfare. Keep the original in a safe but accessible place.

Legal Validity and Requirements for Advance Decisions in the UK

The legal framework for Advance Decisions is provided by the Mental Capacity Act 2005. For an ADRT to be legally valid and binding, it must meet several key requirements.

• You must be 18 or over and have the mental capacity to make the decision at the time you create the document.
• The decision must be specific about the treatment being refused and the circumstances in which the refusal applies.
• If your Advance Decision includes a refusal of life-sustaining treatment, the document must state this clearly in writing, be signed, and be witnessed by someone who is not a beneficiary of your will or your spouse/partner.
• You must not have been influenced by anyone else when making your decision.
• The decision is only applicable when you lack the capacity to make the treatment decision yourself.
• It will not be valid if you have subsequently withdrawn it, created a Lasting Power of Attorney (LPA) for health and welfare after making the ADRT that gives your attorney authority to consent to the treatment in question, or if you have done anything clearly inconsistent with the decision.

Specific Scenarios and Clauses Covered by the Template

A comprehensive ADRT form is designed to help you articulate your wishes for a range of potential future situations. Such forms typically include guidance and clauses that address common scenarios.

• Refusal of Life-Sustaining Treatment: A specific section for you to explicitly refuse treatments like artificial nutrition and hydration, resuscitation, or ventilator support in defined terminal or irreversible conditions.
• Refusal in Cases of Permanent Unconsciousness: Clauses covering situations such as a permanent vegetative state or minimal consciousness.
• Refusal in Advanced Progressive Conditions: Guidance for outlining refusals in the late stages of illnesses like dementia, motor neurone disease, or advanced cancer.
• Religious or Personal Belief Refusals: Space to specify refusals based on faith or personal conviction, such as blood products or certain surgical procedures.

The Difference Between an Advance Decision and a Living Will

The terms are often used interchangeably, but in a UK legal context, there is a subtle distinction. An Advance Decision to Refuse Treatment is the specific, legally defined term under the Mental Capacity Act 2005 for a document that refuses treatment. It is this legal definition that gives it its binding power. A "living will" is a broader, informal term that can refer to any document expressing future healthcare wishes, but only a formal ADRT is legally binding in refusing treatment. This document creates a formal ADRT.

The Role of the Mental Capacity Act 2005

The Mental Capacity Act 2005 is the cornerstone of law governing decision-making for adults who may lack capacity. It provides the statutory basis for Advance Decisions, ensuring they must be respected by healthcare professionals and the National Health Service (NHS). The Act sets out the principles for assessing capacity and confirms that a person has the right to make decisions about their future care, including refusals, while they have the capacity to do so.

Frequently Asked Questions About Advance Decisions to Refuse Treatment

What are the requirements for making an advance decision to refuse treatment in the UK?

You must have mental capacity when making it, it must be specific about treatments and circumstances, and if it refuses life-sustaining treatment, it must be in writing, signed, and witnessed. It must also be made voluntarily without pressure from others.

Can you provide an example of an advance decision to refuse treatment (ADRT)?

An example would be a statement such as: "If I suffer a severe stroke and am left in a permanent vegetative state with no reasonable hope of recovery, I refuse any life-sustaining treatment including artificial nutrition and hydration and antibiotic treatment for subsequent infections." A well-drafted form helps you build such statements correctly.

Can a patient refuse treatment in the UK?

Yes, a patient with mental capacity has the absolute right to refuse any medical treatment for any reason. An Advance Decision extends this right to a future time when capacity may be lost.

What are the legal protections for refusing medical treatment in the UK?

The primary legal protections are the common law right to bodily integrity and the statutory framework of the Mental Capacity Act 2005, which codifies and strengthens the right to make an Advance Decision.

How can an individual make an advance decision?

By carefully considering their wishes, discussing them with a healthcare professional, and completing a clear written document like a suitable template, ensuring it is signed and witnessed correctly.

Can you provide me with a template for an advance care plan in the UK?

This document serves as the legally binding Advance Decision to Refuse Treatment, which is a core component of advance care planning. For broader wishes about care preferences that are not refusals, a separate Advance Statement can be used alongside this ADRT.

Download our free Advance Decision to Refuse Treatment form and start planning your future care.