Advance Decisions to Refuse Treatment

ADRT's can only be made when the person making it:

1. Is aged 18 or over at the time it is made; and
2. Has capacity to do so.

The following information must be clearly set out in the ADRT:

1. The specific circumstances where treatment is to be refused or withdrawn; and
2. The specific treatment that is being refused or is to be withdrawn.

If specific circumstances and treatments are not clearly set out in the ADRT it is not valid. It is therefore important that the ADRT is clearly recorded either in a separate written document or, if made orally, in the person’s medical and/or adult social care records.

Where the ADRT includes refusing life-sustaining treatment, the person must prepare a written statement specifically setting out that the treatment is to be refused or withdrawn even if their life is a risk. This statement must then be:

1. Signed by the person (or another person under their direction if they are physically unable to sign); and
2. The signature is made or acknowledged by the person in the presence of a witness; and
3. The witness signs it, or acknowledges his signature in the person's presence.

The Advance Decision to Refuse Treatment can be withdrawn or altered at any point by the person who made it, so long as they have the capacity to do so.

The withdrawal of an ADRT (either in full or partially) does not need to be given in writing; this allows for the person to withdraw it urgently if required.

The alteration of an ADRT does not need to be given in writing, unless the alteration relates to the addition of a refusal to receive life sustaining treatment.

In this case, the additional requirements for life sustaining treatment set out above apply.

The ADRT will also be invalid if the person has done anything since making the ADRT that is inconsistent with the advance decision remaining their fixed decision.

The Advance Decision to Refuse Treatment can only be used if:

1. The person was 18 or over when the decision to refuse or withdraw treatment was made; and
2. The person had capacity when the decision was made; and
3. The person lacks capacity to make a decision now; and
4. The person has not subsequently made a Lasting Power of Attorney that gives an Attorney the power to make a decision over the treatment specified; and
5. The circumstances in which the ADRT should be used are clear; and
6. The treatment that is being refused is clear; and
7. The person has not done anything else that is clearly inconsistent with the ADRT remaining their fixed decision.

If all of these apply the ADRT, should be given the same authority as if the person had capacity and is making the decision themself.

The Advance Decision to Refuse Treatment cannot be used when:

1. The person has capacity to consent or refuse treatment; or
2. The treatment is not the treatment specified in the ADRT; or
3. The circumstances of the person are not those specified in the ADRT; or
4. The person has subsequently made a Lasting Power of Attorney authorising the Attorney to make a decision regarding the specific treatment set out in the ADRT; or
5. There are reasonable grounds to believe that circumstances or information exits which, if the person had been aware of would affect the ADRT; and
6. In the case of life sustaining treatment, the person has not made a valid statement authorising the treatment to be withdrawn or withheld 'even if life is at risk'.

The Lasting Power of Attorney cannot provide powers to any Attorney to alter or withdraw an Advanced Decision to Refuse Treatment unless that Lasting Power of Attorney itself specifies that the Attorney can make a decision about the specific treatment that is to be provided.

Where a health practitioner reasonably believes that there is a valid ADRT that is applicable to the treatment and circumstances of the person, the Mental Capacity Act protects them from liability if they:

1. Withhold treatment; or
2. Withdraw treatment.

Where health practitioners reasonably believe that there is no ADRT or that an ADRT is not applicable to the treatment and circumstances, the Mental Capacity Act protects them from liability if they:

1. Provide treatment;
2. Continue to provide treatment; and
3. Provide life sustaining treatment.

Where there are reasonably grounds for questioning the validity or terms of an ADRT, health practitioners can continue to provide life-sustaining treatment or treatment to prevent a serious deterioration in the person’s condition until:

1. The validity of any purposed ADRT is tested; or
2. A decision is made by the Court of Protection about continuing specific treatment.