Questioning the validity of an advanced decision to refuse treatment

The main aim of the Mental Capacity Act 2005 is to promote valid choice by putting the person at the centre of decision-making and giving effect to that person's wishes (Department for Constitutional Affairs, 2007).

Advance decisions to refuse treatment allow an adult with capacity to set out the treatment they would wish to refuse at some future point when they lacked capacity to make the decision themselves (Mental Capacity Act 2005, section 24). Nurses are protected from liability if they stop or withhold treatment because they reasonably believe a valid and applicable advance decision exists (Mental Capacity Act 2005, section 5).

The Law Commission (1995) defined an advance decision refusing treatment as:

‘A refusal made by a person aged 18 or over with the necessary capacity of any medical, surgical or dental treatment or other procedure and intended to have effect at any subsequent time when he or she may be without capacity to give or refuse consent.’