An advance decision to refuse treatment (ADRT), sometimes called a living will, is a legally binding document in England and Wales that sets out specific medical treatments a person does not want to receive in the future, in case they are unable to make or communicate that decision at the time.
Legal status
Under the Mental Capacity Act 2005, a valid and applicable ADRT has the same legal force as a contemporaneous decision made by a person with full capacity. Healthcare professionals must follow it if it meets the required criteria.
What an ADRT can cover
An ADRT can refuse any medical treatment, including life-sustaining treatment such as cardiopulmonary resuscitation (CPR), mechanical ventilation, and artificial nutrition. It cannot be used to request a specific treatment (that is done through a different document, an advance statement of wishes), and it cannot be used to request anything unlawful.
Validity requirements
For an ADRT to be valid, the person must have had capacity when they made it, must not have done anything clearly inconsistent with it since, and the document must apply to the specific situation that has arisen. For an ADRT that refuses life-sustaining treatment, it must be in writing, signed, and witnessed.
Why cardiac arrest survivors may consider one
After experiencing cardiac arrest, some survivors think carefully about what they would and would not want in the event of a future medical crisis. An ADRT allows a person to ensure their wishes are followed if they become unable to speak for themselves. This is separate from a DNACPR order, which is a clinical decision made by a doctor.
How to make one
ADRTs can be written independently, using templates from organisations such as Dying Matters or Compassion in Dying, or with the help of a solicitor. It is important to discuss the decision with your GP or cardiologist so that the document can be placed in your medical records.
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