What is an Advance Decision to Refuse Treatment?

An Advance Decision to Refuse Treatment or ADRT (also sometimes called a living will) is a voluntary decision you can make, if you have the mental capacity to do so, to refuse a specific type of treatment in the future. It lets your family, carers and health professionals know your wishes in the event that you are unable to communicate them yourself. The treatments you decide to refuse must all be named in the ADRT. Sometimes you may wish to refuse a treatment in some situations but not others. If this is the case, you need to be clear about all the different circumstances. There is no set format for an ADRT unless you wish to refuse life-sustaining treatment, such as ventilation or CPR (cardiopulmonary resuscitation) in which case your ADRT must be written, signed by you and witnessed.

Is an Advance Decision legally binding?

Yes. This is a precise way of expressing a decision not to have a specific treatment in specific circumstances in the future and is binding provided that the ADRT is valid and applicable. These decisions must also be your own decisions.

What does an Advance Decision form look like?

It can be a simple form which you fill in yourself. Trinity staff can show you an example. You are also free to write your own but it must follow a certain format if you decide to refuse life-sustaining treatment.

Who needs to know that I have made an Advance Decision?

You must ensure that the key people and organisations involved in your care have a copy of your ADRT. This will help to avoid difficult situations, especially if an emergency arises. We can give guidance and support to help you do this. A time may come when you are unable to tell the health professionals involved in your care about your ADRT. This is why you should ensure copies are in relevant medical records.

Can I name someone to make decisions on my behalf if I do not want to or if I become unable to?

Yes. This is called appointing a Lasting Power of Attorney.

Does my Advance Decision need to be witnessed?

Yes. If you are writing an ADRT, your witness must sign it in your presence and should be someone who is independent and has nothing to gain as a consequence of the ADRT. If you cannot sign, you can direct someone to sign for you, in front of you and the witness.

Who should I talk to about the types of treatment I don’t want?

It is advisable to talk your Advance Decisions through with your close family, although you are not obliged to do so. To ensure that your decisions are clear and that you understand the implications, you should also discuss them with the hospice doctor or nurse, or your GP.

Does a doctor have to sign my Advance Decision?

No, but we advise you to include details of the doctor you have discussed the ADRT with as a point of contact for the future.

Can I change my mind?

Yes, you can change your mind about all or any part of your ADRT. Simply inform all the people and organisations that have a copy of your earlier ADRT that it is now invalid and should be destroyed.