What is an Advance Decision?
An Advance Decision to Refuse Treatment (or ADRT) is a decision made now to refuse specific medical treatment in the future. Medical treatment means things like (for example) medication, or being put on a ventilator if you can’t breathe on your own. The Decision only applies if you lack mental capacity to give or refuse consent to medical treatment at some time in the future.
An Advance Decision can be made verbally or in writing, and there is no set form to make one. But, if the Advance Decision refuses life-sustaining treatment it must be in writing and witnessed.
The consequences of making an Advance Decision can be very serious. Anyone thinking of making one should think very carefully about what it might mean for them and those who care for them, such as family and friends.
What does an Advance Decision have in it?
Advanced Decisions should include:
- Any specific type of treatment that is refused.
- The circumstances in which that treatment is refused.
The Advance Decision could also include:
- Reasons for refusing specific treatment.
- A statement of wishes and preferences about any other treatments.
- Details of anyone that professionals should speak to help them understand your wishes and preferences.
If the Advance Decision refuses life-sustaining treatment, it MUST:
- be in writing
- include a statement which says clearly that the Decision applies even if your life is at risk or will be shortened as a result of refusing treatment.
- be signed and dated by you in the presence of a witness.
- be signed and dated by the witness.
Who can make an Advance Decision?
You can make an Advance Decision if you are:
- Aged 18 or over
- Have the mental capacity to make the decision.
For more information on what it means to have mental capacity, please go to our page on the Mental Capacity Act 2005.
Is an Advance Decision legally binding?
If it is valid, and applicable to the situation that arises, an Advance Decision is legally binding. It doesn’t matter whether others agree with what is written in the Advance Decision. If the Decision is valid and applicable, it must be followed, even if others think that the decision in it is not in your best interests.
Being valid and applicable means that the Advance Decision is relevant to the situation or circumstances that have arisen, and to the treatment that you need at the time. For example, if your Advance Decision states that if you have dementia and refuse all life-sustaining treatment, but you don’t actually have dementia, the refusal of life sustaining treatment won’t apply. Similarly, if your Advance Decision refuses a blood transfusion, but a transfusion is not what you need at the time, the refusal won’t apply (it will only apply when or if you need a transfusion). In both these examples, the Advance Decision is not relevant to the circumstances that have have arisen. Advance Decisions are limited by what you put in them, and the situation that occurs.
It is up to medical professionals to decide whether the Advance Decision applies. If a professional decides that it does not apply, they must still take it into account when deciding what treatment is in your best interests.
Advance Decisions can’t:
- refuse basic or essential care to keep you comfortable (such as warmth or shelter).
- be used to force professionals to give specific treatment.
- change the law on euthanasia and assisted suicide (helping someone to end their life is illegal).
- generally, refuse treatment for mental health problems if you are sectioned under the Mental Health Act 1983 at the time the treatment is needed (for example you cannot refuse medication if you are sectioned. The exception to the general rule is that you can refuse electroconvulsive shock therapy or ECT, even if you are sectioned at the time the ECT is needed).
How do I make an Advance Decision?
Any decision to refuse medical treatment, including an Advance Decision, must be an informed one. This means that you should think carefully about why you want to make an Advance Decision, what you want to achieve by making one, and the benefits and risks of making one.
Although you don’t have to get advice from a medical professional before you make an Advance Decision, it is recommended that you do, for example from your GP or another professional closely involved in your care, such as a specialist. It is even more important to get advice if the Advance Decision refuses life sustaining treatment.
You can find some useful resources including a template for making an Advance Decision using this link.
You might also want to think about getting help from a solicitor to make an Advance Decision. A solicitor will charge for this service.
How do I let people know I’ve made an Advance Decision?
Keep your Advance Decision in a safe place, and share a copy of it with those who support you. This includes anyone close to you who might need to know what decisions you have made, and any professionals who might help you, such as your GP. It is very important that the people who might need to apply your Advance Decision know that it exists.
If you change your Advance Decision, you will need to make sure that you share the new copy of it with those close to you and those helping you, so that they can stay up to date.
Can I change my mind about an Advance Decision?
Yes, while you have the mental capacity to do so. You should review your Advance Decision and update it if you think that something has changed. It is recommended that you review your Advance Decision at least every two years, or earlier if something important changes.
An Advance Decision will not apply if:
- it has been withdrawn whilst you have the mental capacity to withdraw it.
- you act in a way that shows that what is in the Advance Decision is no longer what you want. For example, if you converted to a different religion after you made the Advance Decision, and that religion have different view about certain treatments, that might mean you’ve changed your mind.
- something has happened which you could not have thought about at the time that you made the Advance Decision. For example, if you got pregnant after you made the Advance Decision, your pregnancy might change how you feel about the future.
- after the Advance Decision was made, you gave an attorney the authority (by way of a Lasting Power of Attorney document) to give or refuse consent to the treatment that is covered by the Advance Decision.
What if there is a disagreement about my Advance Decision?
If there is a disagreement about whether your Advance Decision is valid and applicable, or for any other reason, and this can’t be resolved, the Court of Protection can make a decision on what should happen.
You can read more about the Court of Protection using this link.