An Advance Decision to Refuse Treatment (ADRT), often known as an Advance Directive, is a decision a person makes in advance to refuse a specific type of medical treatment or care if they later become unable to make decisions for themselves.

In the UK, the only person who can make an Advance Decision is the person themselves who the decision will apply to. This means that family members, partners, doctors or other healthcare professionals cannot make an ADRT on someone else’s behalf. This is an important aspect of an ADRT as it revokes the ability for others to make treatment decisions, providing autonomy to the individual regarding their future healthcare.

Consider an example where bariatric surgery is refused in case of future severe obesity. The individual concerned would need to write an ADRT which is clear this is their own decision, made with adequate understanding, free of any coercion or misinformation.

It is crucial to note that you have to be 18 years or over and have the mental capacity to make the decision. That is, they should be able to understand, retain, weigh up the information relevant to this decision and communicate it. The ADRT becomes legally binding once it meets the criteria set out in the Mental Capacity Act 2005 and any amendments thereafter.

Remember to thoroughly think through the implications, consult with healthcare professionals if needed, and make your ADRT specific to your circumstances and wishes. Services like myADRT can help simplify this process by offering a platform to quickly and easily fill in, register and download ADRT forms.

The subsequent questions arising from knowing who can make an advance decision might include:

1. “What are the legal requirements for making an advance decision in the UK?”
   In the UK, an Advance Decision to Refuse Treatment (ADRT) can be made by any competent individual over the age of 18 who wishes to state their choice to refuse specific medical treatment for a future time when they may lack the capacity to communicate or make this decision. This is in accordance with the Mental Capacity Act (2005).

Several legal requirements must be fulfilled for an ADRT to be valid and applicable:

a) Voluntariness: The decision should be made voluntarily, without influence or coercion from others.

b) Capacity: The person must have the mental capacity to understand, retain and weigh the information relevant to the decision, and communicate it.

c) Specificity: The decision must clearly specify which treatments the person wants to refuse, and under what circumstances.

d) Life-sustaining treatment: If the advance decision includes refusal of life-sustaining treatment, this must be in writing, signed, and witnessed. The statement must specify that the advance decision stands “even if life is at risk”.

2. “What is the role of a witness in making an ADRT?”
   A witness in the process of making an ADRT has the key role of verifying that the person making the ADRT has signed the document of their own free will, without undue influence or pressure from others. This is particularly important when the ADRT includes decisions about refusing life-sustaining treatments. The witness should also sign the ADRT to confirm this.
3. “What happens if I change my mind after making an ADRT?”
   If you change your mind after making an ADRT, you can amend or cancel it at any time, as long as you have the mental capacity to do so. This must be done clearly and ideally in writing. You should then inform anyone who has a copy of the original ADRT, such as your GP or family members, and provide them with the new version if necessary.
4. “Can my healthcare team override my ADRT?”
   An ADRT, if valid and applicable, should be followed by your healthcare team. They cannot override your decision without a legal basis, such as when the ADRT does not clearly specify the current situation or the treatment decisions in question. If there’s any uncertainty, the healthcare team should involve the Court of Protection for a decision.
5. “What are lasting powers of attorney (LPA) in relation to an ADRT?”
   A Lasting Power of Attorney for health and welfare is a legal document, separate from ADRT, under the Mental Capacity Act 2005. This process involves appointing one or more people to make or help make decisions on your behalf, regarding personal welfare or healthcare, when you lack the capacity to do so.

If you have both an ADRT and an LPA, and they cover the same treatment decision, the one that was completed later normally has legal precedence. It’s crucial to ensure the instructions in both documents align to avoid any conflicts.

Remember, myADRT provides a free service for UK residents to quickly and easily create, register and download their ADRT. The process and requirements for all the above procedures should be carried out under appropriate legal and/or medical advice.

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.