Advance decisions to refuse treatment

Advance decisions to refuse treatment (ADRTs), as the name suggests, allows an adult with capacity to set out the treatment they would wish to refuse at some future point when they lack capacity to make the decision themselves (Mental Capacity Act 2005, section 24). This includes life-sustaining treatment that would lead to a person's death if withheld or withdrawn.

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). That care and treatment protection is lost if the nurse knew, or ought reasonably to have known, of the existence of a valid and applicable advance decision but did not put it into effect (Mental Capacity Act 2005, section 6).

In NHS Cumbria CCG v Rushton [2018] an NHS clinical commissioning group applied for the court's approval to withdraw clinically assisted nutrition and hydration in respect of an 85-year-old woman who had signed an advance decision, in which she indicated her refusal of certain treatment even if her life was at risk.