Advance Decision to Refuse Treatment (ADRT) is a legally binding document that a person can put in place to refuse specific types of medical treatment in case they become unable to make or communicate their decisions (such as, when they a in a coma, under the effects of powerful medications or seriously ill). ADRT is also known as a living will.

Here’s an example of an ADRT:

A 70-year old woman with a diagnosed condition of Alzheimer’s disease finalises an ADRT wherein she states that, in the event that her cognitive abilities decline to the point where she can no longer recognise her loved ones or manage normal daily activities due to the progression of Alzheimer’s, she doesn’t want to receive artificial nutrition or hydration methods, such as a feeding tube.

In this example, the person is planning for a scenario where she can’t express her wishes about treatment but has clearly stated in her ADRT how she wants to be treated. With this ADRT, her healthcare team and her loved ones would be legislatively obligated to follow her wishes.

Please note that an ADRT must be ‘valid’ and ‘applicable’ to be followed by the healthcare team. By ‘valid’ it means that the person making an ADRT must be 18 or over, have the mental capacity to make the decision, must make the decision voluntarily without any pressure or undue influence and the ADRT must not have been overridden by a later Lasting Power of Attorney. By ‘applicable’, it means the treatments and situations listed in the ADRT must match the person’s current situation.

At https://myadrt.com/, UK residents can quickly and easily create their own ADRT, which they can then register and download for safekeeping and sharing.

Following the explanation of the Advanced Decision to Refuse Treatment (ADRT), the next logical questions would be:

1. How can I make an ADRT?
2. What are the legal requirements for an ADRT in the UK?
3. How can I change or cancel an ADRT?

Let me address each question:

1. How can I make an ADRT?
   Creating an ADRT requires careful thought and potentially difficult reflections about one’s health and personal beliefs. Thus, the first step is usually to have a discussion with healthcare professionals about your health condition, including their prognosis and potential treatment options. This would aid in making an informed decision. After this stage, one could proceed to make an ADRT using the free service provided by myADRT.com, making it clearer for people to document their requests.
2. What are the legal requirements for an ADRT?
   In the UK, for an ADRT to be legally binding, it must meet certain requirements stipulated by the Mental Capacity Act 2005. Firstly, the person must be an adult (18 or older) and have the mental capacity to make, understand, and communicate their decision. The ADRT must be in writing and must be signed by the person and a witness. If the decision is to refuse life-sustaining treatment, this must be clearly stated in the document and must be witnessed.
3. How can I change or cancel an ADRT?
   The process of changing or cancelling (revoking) your ADRT is relatively straightforward. You can change your ADRT at any time as long as you have the mental capacity to do so. If you wish to make changes, you should destroy the original ADRT, make a new one, and ensure everyone (including your GP and close family or friends) is aware of the changes or the revocation. Remember to follow the same process you followed when you made the original document, including ensuring the revised version is properly witnessed.

And finally, it’s important to note that you should regularly review your ADRT, particularly if there’s been a change in medical circumstances. This will ensure the ADRT best reflects your current wishes and that the healthcare team treating you has current knowledge of your treatment preferences.

Remember, whilst this process can be done independently, it’s advisable to discuss these decisions with healthcare professionals and loved ones to ensure your instruction is clear, unambiguous, and most importantly, reflective of your wishes.

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.