Planning Ahead – Advance decisions to refuse treatment
Published: 29/03/2019
As we grow into old age (with we hope, many summers to come!) it is sensible to think about what might happen in the future, were we to become no longer capable of refusing medical treatment. Rather than leave medical staff and next of kin to make unbearably difficult life and death decisions, we can choose to make a legally binding “advance decision” to refuse future medical treatment.
Advance decisions (“ADRTs”) are most commonly made by people who are diagnosed with a terminal illness, or who have particular personal beliefs (including religious and spiritual beliefs) that are relevant to their medical treatment.
For the choice to be valid the person must be over the age of 18 and possess the mental capacity to make the decision.
Right to Refuse Life-Sustaining Treatment
An ADRT can be used to refuse “life-sustaining treatment” i.e. a treatment that could potentially keep you alive. Examples include:
- ventilation – this may be used if you cannot breathe by yourself;
- artificial nutrition and hydration (feeding by tubes);
- cardiopulmonary resuscitation (CPR) – this may be used if your heart stops;
- antibiotics – this can help your body fight infection.
You may want to discuss this with a doctor or nurse who knows about your medical history before you make up your mind as to the exact terms of your ADRT.
Decisions that cannot be made by advance decision
It is important to be aware of the limitations of advance decisions.
- An ADRT can only be used to refused medical treatment – it cannot be used to require a particular treatment. The decision maker can state preferences for different treatments in the ADRT but these will not be legally binding.
- An ADRT cannot be used to refuse care/treatment that is needed to keep the decision-maker comfortable (sometimes referred to as basic or essential care).
- An ADRT cannot be used to request or authorise illegal acts, including assisted suicide.
Where an ADRT meets the statutory requirements it is as effective as a refusal of treatment by a person who has capacity. It overrules a decision made by an attorney acting on behalf of the decision-maker under a health and welfare lasting power of attorney (LPA) and cannot be overruled by the Court of Protection.
Statutory Requirements
An ADRT must satisfy the following requirements:
- It must be in writing and signed by the decision-maker in the presence of a witness.
- The witness must sign the document in the presence of the decision-maker.
- It must include a clear written statement by the decision-maker that the decision is to apply to the specified treatment even if the decision-maker’s life is at risk.
It is best for the ADRT to be made with input from your GP as he or she will be able to identify and accurately describe potential treatments, the circumstances in which those treatments would be offered and their implications for the decision maker patient.
Who should see it?
Your family, carers or health and social care professionals should be informed about your decision. You should also let them know where to find the ADRT. Your family or carers may have to find it quickly if you require emergency treatment and they need to tell the healthcare professionals your wishes. You can keep a copy in your medical records.
Alternatives to an ADRT
You can appoint one or more health and welfare attorneys under an LPA to take decisions about medical treatment in the event of lost capacity. A health and welfare attorney can be given power to refuse consent to life-sustaining treatment, but this power must be expressly set out in the LPA.
For further information see, NHS: Advance Decisions to Refuse Treatment (ADRT).
The organisation Compassion in Dying has a precedent for an Advance Decision with the option of completing the form online (see Compassion in Dying: Advance Decision (Living Will) pack ).
