An Advance Decision to Refuse Treatment (ADRT) under the Mental Capacity Act 2005 in the UK can be invalidated on several grounds.

1. Withdrawal of ADRT: If the person who made the ADRT subsequently withdraws it while they still have capacity to do so, even if they now lack capacity to make treatment decisions, the ADRT is not valid.
2. Granting of Lasting Power of Attorney (LPA): If an LPA is granted after the ADRT was made and the LPA specifically gives the attorney authority to make treatment decisions which would have been covered by the ADRT, then the ADRT is invalidated.
3. Inconsistency in actions or words: If the person has acted in a manner inconsistent with the ADRT since creating it, this may invalidate it. For instance, if someone has stated in an ADRT that they refuse a particular medical treatment, but after making the ADRT they verbally express otherwise during periods of capacity, then the ADRT could be considered invalid.
4. Changes in medical treatment or personal circumstances: If there have been significant changes in the type of treatment available or the person’s circumstances since the ADRT was made, it may not be considered valid unless the person clearly anticipated the change when they made the ADRT. For example, the creation of a new drug which considerably reduces the side-effects of the treatment that was refused in the ADRT would constitute a significant change in treatment.
5. Incorrect execution of ADRT: If the ADRT is not correctly executed, it may be deemed invalid. For example, if the ADRT is refusing life-sustaining treatment, it must be in writing, signed and witnessed.
6. Lack of Capacity: If it is believed that the person did not have capacity to understand the consequences of their decisions at the time the ADRT was drawn up, it cannot be valid.

To be on the safe side, it is usually a good idea to review ADRTs regularly, especially if one’s medical situation or views change. The advantage of using a service like myADRT is that users can easily update, re-register and re-download their ADRTs whenever needed. Correct execution of the form is also ensured, reducing the likelihood of it being found to be legally invalid.

1. Question: How can I ensure that my ADRT (Advance Decision to Refuse Treatment) is valid?

Answer: An ADRT is a document where you can state any medical treatments that you would not like to undergo in the future, in case you’re unable to make or communicate that decision at the time. To ensure your ADRT is valid, it must meet several requirements.

• It must be in writing (Typed or handwritten)
• It must be signed and witnessed.
• It must specify which treatments you’re refusing.
• For life-sustaining treatments, it must clearly state that the refusals apply even if life is at risk.

You should have capacity when making, changing or cancelling these decisions. Additionally, avoid any ambiguous language in the ADRT to prevent confusion or potential challenges to the document. It can also be beneficial to discuss your plans with your medical provider for advice and to ensure they understand your wishes.

2. Question: Can I change an ADRT once it has been created and signed?

Answer: Absolutely, as long as you have the mental capacity to do so. You can change or cancel your ADRT at any time. The changes must adhere to the same rules as creating a new ADRT such as being in writing, signed, and witnessed, specifically if it involves refusing life-sustaining treatment. You should also make sure that any old versions are destroyed to avoid confusion.

3. Question: What should I do with my ADRT after it’s completed?

Answer: Once finished with your ADRT, it’s beneficial to distribute it amongst relevant parties. You could give copies to your GP and medical team, your family and anyone who is close to you. Moreover, you might wish to store a copy with myADRT, where you have completed and registered your document. This allows it to be easily accessible in case of emergency.

4. Question: Does an ADRT need to be reviewed regularly?

Answer: While there’s no specific mandate for how frequently an ADRT should be reviewed, it’s advantageous to do so regularly particularly if your health condition changes. This will ensure that it still accurately reflects your wishes, and if not, amends can be made while you have capacity. The dated signature on the ADRT also serves to reassure medical professionals that the document is current.

5. Question: Can healthcare professional override my ADRT?

Answer: Only under certain circumstances can health professionals override your ADRT. These might include situations where the ADRT is not valid, the treatment being provided wasn’t specified in the ADRT, or your present circumstances were not anticipated, and the refusal specified in the ADRT is not relevant or applicable to the treatment. However, if everything checks out and your ADRT is valid and applicable, they are legally obligated to follow it.

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.