ADRT You have a legal right to refuse in advance specific treatments and treatments in certain circumstances. This is known as an advance decision to refuse treatment (ADRT).

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Why make an ADRT? How do you make an ADRT?

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For people with progressive or life-limiting illnesses, it's often especially important to plan ahead. Many people in this situation fear losing control and not being able to tell health professionals their decisions.

An ADRT becomes active once someone loses the capacity to tell health professionals their decisions themselves

An ADRT becomes active once someone loses the capacity to tell health professionals their decisions themselves.

A valid and applicable ADRT has to be respected and acted upon by anybody, including doctors, nurses and ambulance staff.

An ADRT will help to reduce stressful discussions between health professionals and carers or relatives during a medical crisis, when the person who has made the ADRT might be too ill to communicate their own wishes.

Patients can also refuse life-sustaining treatments, including cardiopulmonary resuscitation, which allows them to die with dignity on their own terms.

This gives them peace of mind and helps professionals to focus on delivering the right care and support.

You don't need a solicitor to make an ADRT, but you do have to be over 18

ADRTs are one part of the Mental Capacity Act 2005, which has now become law. It's designed to protect people, their choices and decisions. You don't need a solicitor to make an ADRT, but you do have to be over 18.

It's a good idea to ask for advice from your doctor (GP or consultant), specialist nurse or social worker in the first instance. However, this is not compulsory and you can make an ADRT without talking to a health or social care professional.

There is a format to be followed when making an ADRT. It should be:

• In writing *
• Give full details of the person making it
• Contain the name and address of GP / recipients *
• State the ADRT should be used if the person lacks capacity
• Specify which treatment(s) in certain circumstances is/are being refused
• Dated (and give dates if it has been reviewed)
• Signed by the person making it
• Signed by a witness at the same time

* This is recommended but not demanded by law.

An ADRT refusing life-sustaining treatment must:

• Be in writing - if the person is unable to write, someone else must write it down for them.
• Be signed by the person making the ADRT - if they're unable to sign they can direct someone to sign on their behalf in their presence. This person must sign in the presence of a witness. The witness must then sign in the presence of the person making the ADRT.
• Include a clear written statement that the ADRT is to apply to a specific treatment 'even if life is at risk'. If this part of the ADRT is made at a separate time it must be signed and witnessed as previously stated.

It's good practice for someone making an ADRT to:

• Discuss their decision with carers, family, health and social care professionals
• Distribute a copy to people who need to know
• Review as necessary, as decisions can change, and withdraw it if necessary

Even if you've made an ADRT, you're always allowed to change your mind.

A doctor can safely provide treatment considered to be in the patient’s best interest unless there is a qualifying, valid and applicable ADRT.

Emergency treatment should not be delayed to look for an ADRT if there's no clear indication that one exists. Should there be any doubt about the validity of an ADRT, professionals must always seek help from someone senior to them.

If necessary, there's a new Court of Protection that will rule on difficult or unresolved matters.

For many people, this type of decision is the most important one they will make. It's essential you get the right information and support if you're considering making an ADRT.

If your GP, consultant or specialist nurse is unable to help, they should be able to point you to a colleague who can.

A special NHS website has been set up to offer specialist guidance and training to health and social care staff, but it's also an excellent resource for patients and carers. The site contains specimen ADRT forms and patient information leaflets..

The Ministry of Justice (formerly the Department for Constitutional Affairs), Department of Health, Office of the Public Guardian and national charities also have information about making an ADRT.

Dr Ben Lobo is a consultant physician and community geriatrician. He's chair of the East Midlands ADRT Project Team and Mid Trent Cancer Network.

This article was first published in October 2007.