An Advance Decision to Refuse Treatment (ADRT), often referred to as a living will, is a legal document that lets individuals express their wishes not to receive particular forms of medical treatment in certain circumstances, in case they’re unable to make or communicate those decisions in the future themselves. The document speaks for you when you are not able to, and it is legally binding in England and Wales.

For an ADRT to be valid and respected by healthcare professionals, certain criteria must be met:

1. Understanding: The person making the ADRT needs to have the capacity to understand the decision they’re making at the time they make it. They need to comprehend what the specific treatments entail, the circumstances under which they’re refusing the treatment, and the potential outcomes and consequences of the refusal.
2. Voluntary Action: Making an ADRT should be a voluntary decision. If there is evidence of pressure, influence, or coercion from another party, the ADRT could be deemed invalid.
3. Present and Clearly Defined Decisions: The refusals of treatment need to be clearly specified in the ADRT. The decision should be applicable in the present illness situation and related to a medical treatment that the person does not want to undergo. It cannot refuse basic care needs such as warmth, shelter, hygiene measures, and the offer of food and water by mouth.
4. Signature: The document must be signed by the individual making the decision, or another person in their presence and under their direction, if the individual cannot do it for themselves due to physical inability.
5. If Life-Sustaining Treatments are Refused: If the ADRT refuses life-sustaining treatments, the document must state this explicitly, and the statement must be witnessed. The witness(es) will sign the document too.

An example of a valid ADRT may be if an individual with a clear understanding and capacity decides they do not wish to receive a blood transfusion under any circumstances, clearly states this in their ADRT document, signs the document, and has it witnessed (if they refuse life-sustaining treatments). It should be noted that any changes in the individual’s treatment preferences or circumstances may require an update in the ADRT. Services like myADRT can assist individuals in properly completing the form.

After understanding the validity of an Advance Decision to Refuse Treatment (ADRT), a person may likely have follow-up questions such as:

1. Are there any conditions that an ADRT cannot refuse?

An ADRT cannot refuse actions that are necessary for comfort care or actions that would alleviate or prevent suffering. For example, you cannot refuse the provision of pain relief (analgesia) or being offered food and drink by mouth. NHS treatment that is not based on what someone is willing to agree to (consensual treatment) such as mental health treatments under the UK Mental Health Act, cannot be refused within an ADRT.

2. How specific do the rejected interventions need to be in ADRT?

In an ADRT, the medical treatments which are being rejected must be specified clearly, along with the circumstances under which these act as directives. The clearer and more specific the information is, the better able doctors will be to respect your wishes. For example, instead of just stating “I don’t want life-support machines,” it’s more helpful to enumerate, such as “I don’t want mechanical ventilation or CPR if I have terminal cancer and my quality of life is severely diminished.”

3. Can an ADRT be changed or revoked anytime?

Yes, an individual can change or cancel their ADRT at any point while they still have the mental capacity to do so. This must be done in writing and notified to all relevant parties, including healthcare providers and family members. If you change your mind about your ADRT, it’s very important to destroy any copies of your old ADRT and replace it with a new updated version.

4. What happens if my circumstances change after creating an ADRT?

If there is a significant change in your health condition that you did not predict when filling out your ADRT, such as receiving a diagnosis of a previously undiagnosed illness, it might mean your ADRT will not apply to your new situation. The best way to make sure your wishes are followed is to revisit your ADRT periodically and whenever there’s a significant change in your medical condition.

5. How do health professionals know I have an ADRT?

It’s your responsibility to inform your healthcare team and close relatives about your ADRT, and ideally provide them with a copy. For example, you could keep a copy with your personal papers, give a copy to a family member or a friend, keep a copy in your record with your GP, or carry a portable document with information on how to access your ADRT.

These answers are meant to address various scenarios or conditions that can arise in relation to creating a valid ADRT and provide the needed guidance to individuals who are considering such an arrangement. Each person’s situation, preferences, and beliefs may differ, so the specific content, conditions, and decisions made in an ADRT can significantly vary from person to person.

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.