Advance Decision to Refuse Treatment
An advance
decision to refuse treatment is when someone, aged 18 years or
above, who has mental capacity, decides that they do not want a
particular type of medical treatment if it was ever needed in the
future and they lacked capacity to make such a decision, for
example due to a stroke, dementia or for some other reason. Family
and friends should be informed of a person’s wishes so that they
can speak on their behalf when needed.
An advance decision to refuse treatment is different from what
is termed “advanced care planning” in ‘end of life’ care. Advance
decisions to refuse treatment under the Mental Capacity Act 2005
are legally binding if valid, whereas many parts of advance care
planning - preferred place of dying, for example – are not.
Anything that is not an advance decision to refuse treatment will
be considered as part of any ‘best interests’ decision about a
person who lacks capacity, but could be overridden by a doctor or
social care professional if they determine it not to be in a
person’s ‘best interests’.
An advance decision can be verbal or written and must clearly
state the exact treatments to be refused and under what
circumstances. It is important that you fully understand the
implications of refusing a particular treatment from a medical
professional. If it is a life-sustaining treatment, it must be
written, signed and witnessed and state clearly that the decision
applies ‘even if life is at risk’. Copies of this should be given
to key people – for example, family or close friends, and a
person’s GP or social worker for their records. It is important
when making an advance decision to ensure it is ‘valid and
applicable’ – this standard form, if fully completed, will be valid
and applicable as an advanced.
We strongly advise that a person also completes the advance decision card
(PDF, 113KB) which they should carry with them in a purse
or wallet to alert others to the fact an advance decision exists.
Health staff will then know who to contact for the information. If
doctors know you have made a valid advance decision to refuse
treatment, they have to respect it. (This document should be
printed out, completed and then folded twice to form a card
sized document.)
A person can change their mind and alter or cancel their advance
decision at any time as long as they have capacity. If medical
advances mean that the outcome of a treatment is quite different to
what was known when your advance decision was made, the validity
can be challenged.
