Yes, an Advance Decision to Refuse Treatment (ADRT) can potentially be ignored in some circumstances, usually to the detriment of the best interests of the patient. This largely depends on the validity and applicability of the ADRT, key factors that are central to whether or not the healthcare professionals involved in the person’s care will honour the refusal of treatment documented within the ADRT.

An ADRT is a legally binding document in which you express your wishes to refuse certain types of medical treatment in particular situations in the future when you may no longer be able to communicate or make decisions due to illness or incapacity. This could be because you are unconscious, because you have dementia, or because you are too unwell to communicate your wishes. It is one of the tools available to you under the Mental Capacity Act of 2005 in the UK.

However, for an ADRT to be considered legally valid and hence be recognised by healthcare professionals, it must meet certain requirements. These include:

1. The person must be 18 or over and have the capacity to make, understand and communicate their decision when making their ADRT.
2. The ADRT should be specific about the circumstances under which they do not want the specified treatments.
3. It should clearly state that the refusal of treatment applies even if their life is at risk.
4. If refusing life-sustaining treatment, the ADRT must be written, signed, and witnessed.

If these conditions are not met, then an ADRT may be ignored by healthcare professionals.

Even if an ADRT is legally valid, it will only be applicable if the circumstances match those described in the ADRT. For example, if your ADRT states that you wish to refuse a particular treatment in an end-stage cancer scenario, this does not mean you can refuse the same treatment if you have a heart disease. Moreover, if new treatments become available after you have written your ADRT, a healthcare professional could argue that your decision may have been different if you had known about these options.

Therefore, it is important to ensure your ADRT is legally valid, specific, up-to-date, and that healthcare professionals are aware of it. You can create, register and download your ADRT through the myADRT service, but it is also advised to discuss your decisions with your doctor and involve them in the process of creating your ADRT. They can guide you through potential medical scenarios and treatments which you might want to consider while drafting your ADRT.

Following the explanation of whether an Advance Decision to Refuse Treatment (ADRT) can be ignored, it is natural to expect queries regarding the circumstances under which an ADRT might not be upheld as well as ways to ensure the desired instructions are respected. Here, we delve into potential queries related to these topics.

1. What are some circumstances where an ADRT may not be fully upheld?

An ADRT may not be implemented under certain situations. Firstly, if there is reason to believe that circumstances have substantially changed since the ADRT was drafted, which would significantly impact the patient’s decision if they were aware. Also, if the Advance Decision does not clearly cover the current situation, i.e., the condition or treatment wasn’t specified in the ADRT, it might not be followed as the health care staff may be unsure of the patient’s wishes. Moreover, ADRT can be overruled if a person has been detained under the Mental Health Act and the treatment is for a mental disorder.

2. How can I ensure my ADRT is upheld at the right time?

To ensure that your ADRT is upheld when required, it needs to be valid and applicable, as per the Mental Capacity Act 2005. Make sure that it is in writing, signed, and witnessed, especially if it involves refusal of life-sustaining treatment. Be as specific as you can with the conditions and treatments you’re deciding against, as vagueness may render your ADRT invalid. Also, regularly review your ADRT, particularly if your health condition changes. Finally, it’s important that your healthcare providers, family, and close friends all have access to your ADRT and are aware of your wishes.

3. What should be included in an ADRT to ensure it is not ignored?

An ADRT should be clear, specific, and detailed. It should specify the treatments you wish to refuse, even if it could risk your life, which must be explicitly stated. It has to be in writing, signed by you and witnessed. It should also include statements explaining that you understand the repercussions of your treatment refusal and that you made the decision voluntarily. If you believe your circumstances may change your decision in the future, include those conditions as well. Through myADRT’s service, you can create a legally binding ADRT and ensure that your health and care professionals, loved ones and carers respect your decisions.

4. What happens if someone disputes my ADRT?

If your ADRT is disputed, a healthcare professional will make the final decision about your treatment in your best interests, based on available information. This might involve an examination of your health, your previously expressed preferences, beliefs and values, and the opinions of your loved ones or carers. If the dispute cannot be resolved, it might have to be refered to Court of Protection, which makes decisions on financial or welfare matters for people who can’t make decisions at the time they need to be made.

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.