The most common type of advance directive is the Advance Decision to Refuse Treatment (ADRT).

An ADRT, also called a Living Will, is a legal document that communicates a person’s wishes about refusing specific types of medical treatment in the future when they may not have the mental capacity to make or communicate their own decisions. It is called “advance” because it is made in advance of the potential medical situations it covers, and “decision” because it records a clear decision that refusal of specific treatment is what the person definitely wants.

In the UK, ADRTs are primarily governed by the Mental Capacity Act 2005. The Act sets out the legal requirements for creating an ADRT including that the person must be 18 or over and have the capacity to make, understand and communicate their decision, the refusal must be clear, and it must specify the circumstances under which it would apply.

To take an example, a person may create an ADRT stating that they would not want to be kept alive using artificial life support if they were to suffer from severe brain damage due to an accident or a stroke, which made it impossible for them to communicate and where there was no reasonable expectation of recovery.

While myADRT website offers the service wherein you can quickly and easily fill in an ADRT form, register it and download it, it is important to remember that the document must be as specific as possible about the treatments and conditions it refers to. It’s also essential that the person you appoint to handle health decisions, or a ‘healthcare proxy’, and healthcare providers know about and understand the document to ensure that the wishes are respected and followed.

Following a detailed explanation on the types of Advance Directives, several follow-up queries might arise possibly relating to:

1. What is included in an Advance Decision to Refuse Treatment (ADRT)?

An ADRT, also known as a Living Will in the UK, is a legal document where an individual lays down their decisions to refuse certain types of future medical treatment. People usually make an ADRT in anticipation that they may lose the mental capacity to make their own choices in future.

An ADRT may include decisions regarding life-sustaining treatments – like the use of ventilators or resuscitation. It should specify the circumstances under which the individual would not want the treatment. It is recommended that it should include personal information, a clear statement of wishes, details about refusal of treatment, circumstances under which the decisions apply, signature of the individual, and signature of a witness.

For example, if a person knows they might reach a point where dementia leaves them unable to recognise loved ones and they wouldn’t want to live in such condition, they could express in their ADRT a refusal of life-prolonging treatment like artificial nutrition and hydration, in certain stages of the illness.

2. How often should you review an ADRT?

Regardless of how diligent you were while creating your ADRT, changes in life circumstances, health situation or medical advancements can alter what is in your best interest medically. Therefore, it’s advisable to review your ADRT regularly, perhaps every two years or after a significant change in health conditions.

For example, if you received an ADRT at 40 when you were relatively healthy but five years later, you are diagnosed with a serious illness, you may want to review your ADRT to ensure it aligns with your current medical situation and your wishes reflecting current values.

3. Can one change an ADRT?

Yes, you can change an ADRT at any time as long as you have the mental capacity to make decisions. Any changes should ideally be made in writing, signed, dated, and witnessed, to prevent any confusion in future. Just as important as changing the document is sharing the changed ADRT with relevant people – family members, healthcare providers, and anyone else who had the old version.

For instance, knowing more about the progression of a disease you have been diagnosed with may change your perception of what treatments you would wish to refuse under specific circumstances.

4. What happens if my ADRT conflicts with my Lasting Power of Attorney (LPA)?

An LPA is another type of Advance Directive where you appoint one or more people (called ‘attorneys’) to make decisions on your behalf if you lack the mental capacity to do so yourself. If an LPA and an ADRT are conflicting, it depends on which was completed last.

For example, if an ADRT refusing life-sustaining treatment is made after a Health and Welfare LPA is in place, the ADRT will have precedence unless the LPA specifically gives the attorney authority to refuse life-sustaining treatment.

In conclusion, while drafting an ADRT can be challenging, resources like myADRT (https://myadrt.com/) can help ensure that the end product accurately reflects your medical wishes, can be easily accessed when needed, and remains legally sound.

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.