Medical treatment can be refused in a number of circumstances. This can be done by the person themselves if they have the capacity to do so, or via an Advance Decision to Refuse Treatment (ADRT), should they lose this capacity.

Capacity, in this context, refers to someone’s ability to make a decision for themselves about their own treatment and care. This includes their ability to understand information about the decision, to weigh up the consequences and risks, and to communicate their decision. This is a fundamental principle in medical law and ethics in the UK.

Anyone with capacity has the right to refuse treatment, even if it could lead to their death. For example, a patient with severe pneumonia may decide to refuse life-saving antibiotics because they feel the quality of their life is too poor, or they have spiritual beliefs that prevent them accepting certain treatments.

An Advance Decision to Refuse Treatment (ADRT) is a decision made by someone when they have capacity, to refuse specific medical treatment in the future when they may not have capacity. It allows people to express their wishes about their healthcare in case they become too ill, injured or unable to express these wishes themselves.

For example, someone with a progressive neurological disease like Parkinson’s may make an ADRT to refuse a feeding tube if they reach a point where they cannot swallow, or a dementia patient may document their wish to refuse resuscitation if their heart stops. This is only legally binding in England and Wales if it is written down, signed, and witnessed, and if the person has clearly stated that the ADRT should apply, even if refusing treatment could risk his or her life.

However, there are some circumstances where treatment cannot be refused. This might apply to people with mental health conditions who are detained under the Mental Health Act, or if the individual is in immediate danger of dying without treatment. The specifics will depend on individual circumstances, legislation and case law, and always involve complex ethical and medical considerations.

It’s always a good idea for individuals to discuss their wishes with healthcare professionals and loved ones, and to record and update these wishes regularly all of which can be done at myADRT.com. By planning in advance for what might happen if they become unable to make decisions, people can help ensure that their wishes are respected, whatever the future holds.

Having previously discussed the circumstances under which medical treatment can be refused, the natural follow-up questions would likely be around the process of refusal, what happens if the patient is conscious versus unconscious, and what rights and protections are afforded to healthcare providers in the event of a refusal.

1) How does one refuse medical treatment in advance?

For individuals wishing to refuse specific medical treatment in the future, this would be carried out through an Advance Decision to Refuse Treatment (ADRT). An ADRT, or “living will”, is a legal document in the UK that allows you to specify treatments you do not wish to receive under certain circumstances. For instance, you might refuse life-sustaining treatment such as artificial nutrition and hydration if you were to develop an advanced terminal illness where these would only prolong the process of dying. It’s essential to remember that an ADRT only comes into effect if you lose the mental capacity to make or communicate your treatment decisions.

2) What happens to the ADRT if I’m unconscious?

If you become unconscious or lose mental capacity, and you have an ADRT that is valid and applicable to your situation, then your doctors and healthcare team must follow your stated wishes to refuse particular treatments. If there’s some ambiguity or contention about the validity or applicability of your ADRT, an urgent court application may be necessary for clarification. It is beneficial always to have your ADRT accessible – for example, via the free myADRT service – to ensure your wishes are known and followed.

3) Do healthcare providers have any protection or rights if they act on an ADRT and something goes wrong?

Yes, healthcare providers are protected under the Mental Capacity Act 2005 in the UK, as long as they comply with its provisions and have acted in good faith. If they are not aware of an ADRT and provide treatment, or if they reasonably believe an ADRT is not valid or applicable, then they would not be liable for following or not following the ADRT. However, deliberately ignoring a known and valid ADRT could potentially lead to charges of assault or battery.

4) Can relatives override an ADRT?

No. Once an ADRT is in effect – that is, once you lack the mental capacity to make or communicate decisions – healthcare professionals must respect your specified wishes, not those of your relatives. Relatives cannot override your ADRT, although they might provide useful insights into what you might have wanted in circumstances not covered by your ADRT.

In undertaking any advance care planning, it is highly advisable to discuss your intentions and wishes with your relatives and loved ones, to avoid any surprises or conflicts at a stressful and emotional time.

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.