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Advance Decision to Refuse Treatment (ADRT)

Summary 

An Advance Decision to Refuse Treatment is a decision you can make now to refuse a specific type of treatment at some time in the future.

  • It is only used if at some time in the future you lose the ability to make your own decisions about your treatment.
  • It is important to discuss the options with a doctor or nurse who knows your medical history.
  • Other terms sometimes used include: ‘advance decision’ and in the past ‘living will’ which is no longer used.

 

Detail

It lets your family, carers and health professionals know whether you want to refuse specific treatments in the future. This means they will know your wishes if you are unable to make or communicate those decisions yourself. It cannot be used to refuse treatment when you still have the capacity to make the decision yourself.

The treatments you are deciding to refuse must all be named in the advance decision to refuse treatment. You may want to refuse a treatment in some situations, but not others. If this is the case, you need to be clear about all the circumstances in which you want to refuse this treatment.

An Advance Decision to Refuse Treatment does not have to be in writing but if you want to refuse life-saving treatment, it must be in writing, must be signed and witnessed, and clearly state that you wish it to apply, even if your life is at risk.

An Advance Decision to Refuse Treatment is a legally binding document as long as it:

If your Advance Decision to Refuse Treatment is binding, it takes the place of decisions made in your best interest by other people. An advance decision to refuse treatment may only be considered valid if:

  • you are aged 18 or over and had the capacity to make, understand and communicate your decision when you made it
  • you specify clearly which treatments you wish to refuse
  • you explain the circumstances in which you wish to refuse them
  • it is signed by you and by a witness if you want to refuse life-sustaining treatment
  • you have made the Advance Decision to Refuse Treatment of your own accord, without any harassment by anyone else
  • you haven’t said or done anything that would contradict the Advance Decision to Refuse Treatment since you made it (for example, saying that you have changed your mind)

If you’ve made an Advance Decision to Refuse Treatment, you can still make a Lasting Power of Attorney (LPA) for health and care. If you want the Advance Decision to Refuse Treatment to be taken into account, you should state this when you have the opportunity to ‘add extra instructions’ in the restrictions and conditions section of your LPA. Send a copy of your Advance Decision to Refuse Treatment to the Office of the Public Guardian (OPG) when you apply to register your LPA.

When making a LPA for health and care, you’ll have to decide whether your attorneys or your doctors should make decisions about life-sustaining treatment. If you let your attorneys decide about life-sustaining treatments that you’ve previously made an Advance Decision to Refuse Treatment about, the LPA will take the place of the advance decision to refuse treatment.

An Advance Decision to Refuse Treatment is not the same as an Advance Statement.

It is important to note that you can make both an Advance Statement and an Advance Decision to Refuse Treatment.