What are Advance Decisions to Refuse Treatment (ADRT) in Health and Social Care?

Advance Decisions to Refuse Treatment (ADRT) is a legal document in the UK. It allows adults to outline medical treatments they wish to refuse in the future if they lose the ability to communicate or make decisions. ADRTs ensure individual preferences are respected, even in difficult circumstances where a person cannot speak for themselves. Always seek professional advice when signing legal documents.

What Does an ADRT Allow?

An ADRT gives you the right to refuse specific medical treatments for future circumstances. It does not give you the power to request a treatment. It’s important to understand that agreeing to your wishes might mean doctors withhold potentially life-saving interventions.

For an ADRT to be valid and legally binding, it must meet strict conditions outlined in the Mental Capacity Act 2005.

Who Can Make an ADRT?

Any adult aged 18 or over in England and Wales can create an ADRT. They must have mental capacity when making it. Mental capacity means being able to understand, weigh up, and communicate decisions.

If a person has already lost mental capacity, it is too late to make an ADRT. In such cases, medical decisions will be made based on the person’s best interests.

Why Make an ADRT?

Creating an ADRT gives people control over their future medical care. It can bring peace of mind by ensuring doctors and loved ones know what treatments are acceptable to you.

For example, you may not wish to:

• Receive CPR (cardiopulmonary resuscitation) if your heart stops beating
• Be put on a ventilator if you are unable to breathe independently
• Receive artificial nutrition and hydration

These decisions can reflect personal, religious, or cultural beliefs.

Legal Conditions for ADRT

For an ADRT to be legally recognised, these key points must apply:

• It must clearly state which treatments you wish to refuse.
• It must outline the circumstances in which these refusals apply.
• It must be signed by you. If you cannot sign, someone must sign it on your behalf in your presence.

If the ADRT includes refusal of life-sustaining treatment (like CPR), then:

• The document must include a statement that the refusal stands even if your life is at risk.
• It must be signed by both you and a witness.

What Treatments Can Be Refused?

You can refuse any treatment, including life-sustaining interventions. Examples include:

• CPR (to restart your heart if it stops)
• Blood transfusions
• Artificial ventilation
• Dialysis (to support kidney function)

You cannot:

• Refuse basic care like food and water given by mouth.
• Demand treatments that healthcare professionals consider inappropriate.

If you’re unsure about what to include, a healthcare professional can advise you.

When an ADRT Is Not Followed

Healthcare professionals must respect a valid, applicable ADRT. However, it may not be followed in certain situations:

1. Doubt about its validity: If the document is missing required signatures, dates, or clear statements, it won’t be legally enforceable.
2. Changed circumstances: If your preferences appear outdated or if you’ve done something that contradicts your ADRT (such as accepting a treatment you had previously refused), it may not apply.
3. Inapplicable treatment: If the treatment or circumstances aren’t described clearly in your ADRT, doctors may proceed with medical interventions to avoid harm.

The Role of Family and Healthcare Providers

Doctors and healthcare teams may consult family members or close friends, especially if the ADRT isn’t clear or complete.

However, family members do not have the legal authority to override an ADRT. Likewise, they cannot demand treatments that go against medical expertise or the ADRT’s instructions.

How to Create an ADRT

Creating an ADRT involves careful thought. Here’s how you can make one:

1. Think about your personal values: Reflect on what matters to you, including your beliefs, quality of life, and medical concerns.
2. Talk to a healthcare professional: You can ask your GP or consultant for advice about certain treatments and their implications.
3. Write down your decisions: Make your preferences as clear and detailed as possible.
4. Meet the legal requirements: Remember to include your signature, witness details (for life-sustaining decisions), and the date.
5. Share your ADRT: Give copies to your GP, loved ones, and legal representatives.

Reviewing and Updating Your ADRT

It’s smart to review your ADRT regularly. Over time, new treatments may emerge, or your preferences might change.

You can update or cancel your ADRT at any time, provided you still have mental capacity. To do so:

• Write a new ADRT if you want to make updates.
• Destroy copies of the previous document.
• Inform healthcare providers and others that you’ve made changes.

What Happens if You Don’t Have an ADRT?

Without an ADRT, doctors will make decisions based on your best interests. This may include consulting family or close friends.

However, these conversations can be emotional and stressful for loved ones. An ADRT removes uncertainty and helps guide decisions according to your wishes.

Legal Safeguards Under the Mental Capacity Act

The Mental Capacity Act 2005 ensures your rights are protected when creating an ADRT. It includes:

• A presumption that you have mental capacity unless proven otherwise.
• Guidance on how decisions should be written and applied in practice.
• Support for healthcare professionals to act in your best interests when no ADRT exists.

Can ADRTs Be Used with Other Tools?

Yes, you might consider combining an ADRT with other planning tools:

• Lasting Power of Attorney (LPA): This allows you to appoint someone you trust to make health and welfare decisions on your behalf if you lack capacity. You can choose whether the appointed person or your ADRT takes priority.
• Do Not Attempt Cardiopulmonary Resuscitation (DNACPR): This is another way of refusing life-sustaining treatment like CPR but is usually discussed with your doctor and added to your medical records.

Where to Keep Your ADRT

Your ADRT should be easy for others to find. Share copies with key people such as:

• Your GP and hospital consultants
• Family members
• Your appointed attorney (if you have a Lasting Power of Attorney)

Consider carrying a card in your wallet that states you have an ADRT and where it is stored.

Common Misunderstandings About ADRT

Some people worry that creating an ADRT means they will be denied all medical care. This isn’t true. An ADRT only applies to the specific treatments you wish to refuse. You will still receive appropriate care and support for your comfort and dignity.

It’s also worth clarifying that an ADRT is not the same as euthanasia or assisted dying, both of which are illegal in the UK. An ADRT does not allow anyone to end your life; it only allows refusals of treatment.

Final Thoughts

An ADRT gives you a voice even if you cannot speak. It’s a powerful way to ensure your healthcare aligns with your wishes. Taking the time to plan not only protects your rights but also makes it easier for your loved ones and healthcare professionals to respect your preferences in difficult situations.

By creating an ADRT, you are taking an important step to stay in control of your future care.