Advance Decisions and Advance Statements
What is an Advance Decision to Refuse Medical Treatment (ADRMT) and an Advance Statement (AS)?
An ADRMT enables someone aged 18 or over, while still capable, to refuse specified medical treatment for a time in the future when they may lack the capacity to consent to or refuse that treatment (Code of Practice chapter 9).
An AS allows you to state how you would like to be treated in the future should you lose the capacity to decide for yourself.
What’s the difference between an ADRMT and an AS?
An ADRMT only allows you to refuse medical treatment and it is legally binding (with certain exceptions). That means that staff would be breaking the law if they gave you a treatment that your advance decision was opposed to.
An AS allows you to say what you would like to happen but is not legally binding.
What are the exceptions to the ADRMT?
If you are being treated under the MHA (1983) then your ADRMT is no longer legally binding for medical treatment decisions about your mental health with the exception of ECT (electro-convulsive therapy) which you can refuse. Of course your care team will take your views into consideration.
If I make a decision that other people don’t like will they assume I lacked capacity when I made it?
One of the principles of the Mental Capacity Act (2005) is the assumption of capacity. The Trust must assume you have capacity unless there are grounds for thinking otherwise. However if there are concerns about the level of capacity you had when you made the ADRMT/AS your wishes may be over-ridden. This is another good reason to talk through your decisions with staff.
If an AS is not legally binding is it worth doing?
Yes! Your care team will always take your views into account and will do their best to abide by them.
Is there a form I need to fill in for either an ADRMT or an AS?
You do not need to write down either your ADRMT (except if it involves life-sustaining treatment – see next page) or your AS but it is much better that you do. Staff and service users at the Trust have made a form for both ADRMTs and ASs and you are encouraged to use these.
Do I need to tell anyone I have made an ADRMT or an AS?
Yes. If staff don’t know about it then they won’t be able to take your decisions and wishes into account. We strongly encourage you to discuss making and ADRMT or AS with a member of your care team and with family or friends.
Where will my ADRMT/AS be kept?
That is your decision but we would recommend that a copy be given to staff to keep with your file. You may also like to give one to your GP and to a friend or family member.
What should I do if I change my mind?
Your advance decision can be amended or withdrawn at anytime and instruction to do so can be given verbally or in writing. It is important that you tell everyone who has a copy of your ADRMT/AS or who you have discussed it with that you have changed it. Try to ensure that all old versions are destroyed.
Can I make an Advance Decision to Refuse Life-Sustaining Treatment?
Yes but it must be in writing and it must be witnessed and it must be in a certain format. Please discuss this with staff.
If you have any questions regarding this advance decision you can contact the following for advice:
- Care co-ordinator;
- General practitioner;
- Citizens Advice Bureau;
- Advocacy Services
Your Advanced Decision will be kept in your file unless you state otherwise. This will allow everyone involved in your care to know your wishes.