An Advance Decision (also known as an Advance Decision to Refuse Treatment, or ADRT) is a legal document where a person specifies what types of medical treatment they would not want to undergo in the future, in case they later become unable to make or communicate decisions for themselves.

The key point to consider here is that by law, an Advance Decision must be made by the person themselves, for themselves. This means that a family member could not write one for another person. The intention behind this rule is that an Advance Decision must accurately reflect that individual’s personal wishes and values, and it is recognised that it may not always be possible for another person, even a close relative, to fully understand or predict what these might be.

For example, let’s consider a woman named Mary. She cannot write an Advance Decision for her ailing husband, John, stating that he would not want a particular treatment if the situation arises. John must create it for himself while he has the mental capacity to make such decisions.

It’s important to remember that while a family member cannot write an ADRT for someone else, they can certainly help that person to understand the ADRT process, discuss different scenarios and treatments, or assist in the practical process of writing or typing up the document. However, the final ADRT must be a true reflection of the individual’s own decisions.

In conclusion, according to UK law and the guidance from myADRT, an Advance Decision must be personally made by the individual and cannot be written solely by a family member or other person. The focus is to maintain the autonomy and personal choice in healthcare decisions. If an individual is unable to write or understand the document, professional medical and legal advice should be sought.

Following the clarification that a family member can indeed write an Advance Decision to Refuse Treatment (ADRT) on behalf of the individual concerned if that person lacks the capacity to do so themselves, a number of further questions may naturally arise.

1. When is an ADRT legally binding?

An ADRT is legally binding in the UK if the person was 18 or over and had mental capacity when they made it; they’ve clearly stated which treatments they don’t want and in what circumstances; they signed and correctly dated their decision in the presence of a witness who then also signed it. Furthermore, for a decision to refuse life-sustaining treatments, it must include a clear statement that the decision applies even if the person’s life is at risk.

2. How long does an ADRT remain valid?

An ADRT is considered valid and applicable indefinitely unless the person has explicitly revoked it, or if there is a reasonable presumption that circumstances have changed significantly since its creation that would’ve led to different decisions being made.

3. What can the ADRT include?

An ADRT can provide explicit instructions on refusal of specific types of medical treatments in certain circumstances. For example, a person could state that they would not want any life-sustaining treatments if they were ever in a permanent and incurable vegetative state. However, the ADRT can’t request procedures that are illegal, such as euthanasia, or require healthcare professionals to give a specific treatment.

4. Can the ADRT be changed?

Yes. As long as the person still has mental capacity, they can alter or revoke their ADRT at any time. Any changes or revocations, just like the original document, should be made in writing, signed, dated and witnessed. It’s best to destroy prior versions to avoid any confusion.

5. What happens if the person’s health condition changes?

If a person develops a condition that wasn’t specified in the ADRT or their condition significantly worsens, the ADRT might not apply. It would be up to the healthcare professionals involved in the person’s care to interpret the ADRT in light of the new circumstances.

6. How is an ADRT put into effect?

Once completed and signed, the ADRT should be given to the person’s GP and any other healthcare providers involved in their care. The individual should also discuss their ADRT with their family and/or carers to make sure that they are aware of their wishes. It can also be registered on the myADRT website, which offers a free service for creating, registering and storing ADRTs.

7. What if there’s a conflict between person’s ADRT and the views of their family or healthcare team?

If there is a disagreement about the person’s treatment, and they lack the capacity to make or communicate their wishes, then their ADRT should normally be followed. Any disagreements would have to be resolved in the courts. However, it’s best if all parties discuss these potential issues in advance to avoid any conflicts at a later date.

If you are considering creating an ADRT or updating an existing one, we encourage you to register your ADRT form with myADRT by visiting https://myadrt.com/register/  By registering with myADRT, you can ensure that your document is created, stored, and shared more efficiently with healthcare professionals and trusted individuals involved in your care.

Additionally, please consider sharing the myADRT service with your friends, family, or loved ones who may also benefit from having an ADRT in place. By spreading the word about this valuable service, you can help others take control of their future medical care and ensure their wishes are respected even when they are unable to communicate them personally. Registering an ADRT with myADRT is a proactive step towards peace of mind for both you and the people who care about you.