Understanding Advance Decisions to Refuse Treatment (ADRTs)
An Advance Decision to Refuse Treatment — also known as a living will — is a legal document that allows you to refuse specific medical treatments in the future, in case you’re unable to communicate your wishes at the time the decision needs to be made.
Making an ADRT can give you peace of mind that your choices will be respected, even if you’re not able to speak for yourself.
What Is an ADRT?
An ADRT is a written statement where you can specify the treatments you do not want to receive in certain situations, should you lose capacity to make or communicate decisions. It allows you to retain control over your healthcare, even in difficult or unexpected circumstances.
You can use an ADRT to refuse treatments such as:
- Life-sustaining treatments (e.g. CPR, ventilation, artificial nutrition or hydration)
- Blood transfusions
- Surgery
- Antibiotics
- Any other medical intervention
It’s important to note that you can only refuse treatment — you cannot demand or request specific treatments.
Legal Status of an ADRT
In England and Wales, ADRTs are legally recognised under the Mental Capacity Act 2005. For an ADRT to be legally binding, it must:
- Be made while you have mental capacity
- Clearly specify the treatments you are refusing
- Explain the circumstances under which the refusal applies
- Be signed and witnessed
- Include a statement that you are refusing life-sustaining treatment, if applicable, and that you understand the consequences
If these conditions are met, healthcare professionals are legally required to respect your wishes.
ADRTs and Life-Sustaining Treatment
If you are refusing life-sustaining treatment (such as resuscitation, artificial feeding, or being put on a ventilator), the form must clearly say so. It must also include a statement confirming that you understand this refusal may result in your death.
Without this, the ADRT may not be legally binding when it comes to life-sustaining care.
ADRT vs. Lasting Power of Attorney (LPA)
Many people choose to set up both an ADRT and a Lasting Power of Attorney (LPA) for Health and Welfare. However, it’s important to understand how the two interact:
- If your ADRT was made after your LPA was registered, the ADRT takes precedence for any decisions it covers.
- If your LPA was registered after your ADRT was created, and your attorney has the authority to make the same type of decisions, your attorney’s decisions take precedence.
To avoid confusion or legal conflict, it’s best to make sure your ADRT and LPA are consistent with each other. Keep both documents up to date and share them with your GP, hospital team, and those closest to you.
When Does an ADRT Apply?
It only applies if:
- You lose the mental capacity to make or communicate the decision at the time it’s needed.
- The specific situation and treatment are clearly covered by the ADRT.
If you still have capacity, your current wishes always take priority.
Making an ADRT
There’s no official form for making an ADRT, but it must meet the legal requirements to be valid. It’s a good idea to:
- Discuss your wishes with your GP, end fo Life Doula or healthcare provider
- Use a template from a trusted organisation like Compassion in Dying
- Let your family and carers know about the document and where it’s stored
- Give a copy to your GP, hospital, and any care providers
Final Thoughts
An Advance Decision to Refuse Treatment — or living will — is a powerful way to ensure your healthcare wishes are respected, even when you can’t speak for yourself.
By planning ahead, you give your loved ones clarity and help healthcare professionals act with confidence, knowing they are following your instructions.
Whether used on its own or alongside a Lasting Power of Attorney, an ADRT is a vital tool for end-of-life planning and personal autonomy.