An advance decision to refuse treatment (ADRT) is a legal way to record which treatments you do not want. It’s used if you cannot communicate in the future. It can include different treatments. For example, mechanical ventilation, artificial feeding, blood transfusions, or resuscitation.
This information is for people living in England and Wales. It explains what an ADRT is, when it can be used, and how to make one.
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What is an ADRT?
An ADRT is a decision to refuse a specific medical treatment. It’s sometimes called an advance decision or living will.
It tells other people that you do not want certain treatments, if you cannot communicate that decision yourself.
An ADRT is not the same as an advance care plan. Advance care plans record what matters to you. For example, where you would prefer to be cared for. They are not legally binding.
ADRTs can be part of your advance care plan, but they need to be recorded properly. See How to make an ADRT below.
Is an ADRT legally binding?
In England and Wales, an ADRT is legally binding under the Mental Capacity Act 2005. This means that your doctor or nurse must follow your ADRT if:
- it’s valid (written and signed correctly) and
- applies to your current situation.
Advance directives in Scotland and Northern Ireland
There is no direct legal equal to an ADRT in Scotland and Northern Ireland. But healthcare professionals should still consider your wishes to refuse treatment. A court may follow your wishes, but they are not protected by law.
Who can make an ADRT?
You can make an ADRT if you:
- are over the age of 18 and
- understand what making one would mean for you (have mental capacity).
Does an ADRT need to be in writing?
You must put a decision to refuse life-sustaining treatment in writing. Life-sustaining treatment is any treatment that tries to keep you alive. Some examples are:
- mechanical ventilation to help you breathe
- feeding tubes if you cannot swallow
- cardiopulmonary resuscitation (CPR) if your heart stops beating.
You can make an ADRT verbally. But this will not count for life-sustaining treatment.
It’s best to speak to your doctor or nurse. They can help you decide which treatments you’d like to refuse and whether it should be written down.
How to make an ADRT
You might want to speak to a doctor or nurse who knows your medical history. They can help you write down which treatments you wish to refuse and in which circumstances. And they might have a template or form you can use.
If you choose to refuse life-sustaining treatment, you must include a specific statement. This should say: ‘I refuse this treatment even if my life is at risk as a result.’
A written advance decision to refuse treatment should be:
- written down and
- signed by you and
- signed by a witness (if you want to refuse life-sustaining treatment).
It’s a good idea to share your ADRT with your healthcare professionals so they know which treatments you do not want. You can ask for your decision to be recorded in your medical records.
Keep a copy of your written decision somewhere safe. You may need to show it to healthcare professionals in the future. You could also let someone close to you know where they can find it, in case of an emergency.
What you can include in an ADRT
In an ADRT, you can:
- say which treatments you do not want
- say in which circumstances you want to refuse treatment
- refuse treatment that could potentially keep you alive, such as a mechanical ventilator to help you breathe.
In an ADRT, you cannot:
- refuse care to make you comfortable, like keeping you warm, clean, safe, and giving you food and water by mouth
- ask for help to end your life.
An advance decision to refuse treatment is not the same as assisted dying. Assisted dying is not legal in the UK.
Example of an ADRT
Here’s an example of how to write an ADRT. These are only examples. You can include other treatments or situations.
It’s best to speak to your doctor to understand which treatments you might need in the future. And in which circumstances you might want to refuse them.
| I wish to refuse the following treatments | In these circumstances |
|---|---|
| I wish to refuse the use of a mechanical ventilator machine. I am refusing this treatment even if my life is at risk as a result. | If I have a terminal illness and my heart and lungs stop functioning in a way that allows me to breathe on my own. |
| I wish to refuse artificial feeding or hydration. I am refusing this treatment even if my life is at risk as a result. | If I have a terminal illness and I can no longer swallow food or liquids safely, even with the help of others. |
When can an ADRT be used?
An ADRT is only used if you cannot make or communicate your own decisions about treatment. For example, it may be used if you’re unconscious in an emergency, and cannot say which treatments you do not want.
ADRT and lasting Power of Attorney
If you have a lasting Power of Attorney for health and welfare decisions, it’s important to think about how this will work with an ADRT.
The most recent decision usually takes priority. For example, you may have made a lasting Power of Attorney. If you later made a valid ADRT refusing a treatment, your attorney would not be able to agree to that treatment for you.
You may want to get advice from a legal professional if you’re unsure.
ADRT and do not attempt cardiopulmonary resuscitation (DNACPR)
A DNACPR decision is a way of recording that healthcare professionals should not try to restart your heart if it stops beating. It helps them know what to do in an emergency. It is sometimes known as a do not attempt resuscitation (DNAR) decision or a do not resuscitate (DNR) decision.
If your doctor does not think CPR would work for you, they will usually discuss this with you. And they should tell you if they have made a DNACPR decision.
A DNACPR decision:
- only applies to CPR
- is not legally binding
- does not need to be written or signed by you.
Some people prefer to make an ADRT for CPR so that their decision is legal binding. Or to communicate specific situations where they would not want CPR.
An ADRT makes refusing CPR legally binding, if it’s:
- written signed and witnessed correctly and
- applies to your situation at the time.
If you’d specifically like to refuse CPR, speak to your doctor or nurse. They can advise you whether making an ADRT would be beneficial.