Author: a_simpson

Advance decision to refuse treatment
Do your family know your wishes
for your care?

This leaflet can help you to talk openly with your family and friends, and the professionals involved in your care if you so wish.

What is an advance statement or advance decision?
Some people choose to plan ahead if they are facing a progressive illness. Before their illness becomes too severe, and whilst they can still make their own decisions, some people may want to record what treatment and care they wish to have in the future. These records can only be used if you are too unwell to communicate your wishes, which in legal terms is called ‘lack of capacity’.
There are differences between an advance statement and an advance decision to refuse treatment which are explained below. You do not have to make an advance statement or decision, and it can be changed or cancelled at any time.
What is an advanced statement?
This is a way to record a person’s wishes and preferences for their future treatment and care.
It is not legally binding.
It can help the team looking after them to determine what care is in their best interest, if they are unable to make their own decisions.
An advanced statement could include where you would like to be cared for, for example in hospital, at home or in a hospice. You could also mention any spiritual or religious beliefs to be respected and reflected in your care.
It only reflects a person’s wishes at the time it is written and
circumstances can change. We recommend that people review their wishes regularly, and if any changes are made, the old document is destroyed.
If you need information in a different format, such as easy read, large print, BSL, braille, email, SMS text or other communication support, please tell your ward or clinic nurse.

What is an advance decision to refuse treatment?
An advance decision to refuse treatment (ADRT) is a decision you can make now to refuse a specific treatment at some time in the future.
It is legally binding.
It gives your family, friends and health professionals legal instructions about specific treatments you would not be willing to have if you are unable to communicate your wishes.
You may wish to refuse a treatment in some situations, but not in others, so this must be clearly stated.
You will always receive basic comfort and care.
Refusing life-sustaining treatments
You can refuse treatments that may have a chance of keeping you alive, often referred to as ‘life-sustaining treatments’. These include cardio-pulmonary resuscitation (CPR) which may be used if you are unable to breathe or if your heart stops, mechanical ventilation to help you breathe, and antibiotics to help your body to fight infection.
You might want to discuss this with the medical team looking after you, who know your medical history, before making a decision. If you wish to refuse life-sustaining treatments in the future, each treatment must be listed separately. Your advance decision must be written down stating clearly that decision applies even if life is at risk and signed by you and signed by a witness. A sample of an ADRT form is available in the cancer information centre or it can be
downloaded
www.macmillan.org.uk/_images/advance-decision-to-refuse-treatment_tcm9-300034.pdf
It is legally binding as long as you are aged over 18 and have the capacity to make decisions when you made it. You must have made the advance decision because you want to and not because anyone has forced you to do so.

You can take this leaflet to help you to discuss your wishes with your GP or your consultant.
Useful resources:
NHS Improving Quality
www.nhsiq.nhs.uk/resource-search/publications/eolc-adrt.aspx
NHS Choices
www.nhs.uk/CarersDirect/moneyandlegal/legal/Pages/Advancedecisions.aspx
Ministry of Justice
www.justice.gov.uk/downloads/protecting-the-vulnerable/mca/ opg-601-0409.pdf
Macmillan website www.macmillan.org.uk
For more information about The Christie and our services, please visit www.christie.nhs.uk or visit the cancer information centres at Withington, Oldham or Salford.
The Christie NHS Foundation Trust
Wilmslow Road
Manchester M20 4BX
T: 0161 446 3000
www.christie.nhs.uk
The Christie Patient Information Service
January 2017 - Review January 2020
CHR/397/27.04.05 Version 5