Adult Social Care Glossary, v 0.6

An advance decision to refuse treatment (ADRT) is a decision to refuse a specific treatment made in advance by a person who has capacity to do so. This decision only applies at a future time when that person lacks capacity to consent to, or refuse, the specified treatment. This is set out in section 24 of the Mental Capacity Act. Specific rules apply to advance decisions to refuse life-sustaining treatment.

An advance decision to refuse treatment:

- can be made only by someone over the age of 18 who has mental capacity
- is a decision relating to refusal of specific treatment and may also include specific circumstances
- can be verbal, but if an advance decision includes refusal of life sustaining treatment, it must be in writing, signed and witnessed and include the statement ‘even if life is at risk’
- will only come into effect if the individual loses capacity
- only comes into effect if the treatment and any circumstances are those specifically identified in the advance decision
- is legally binding if valid and applicable to the circumstances
- can be overridden by the Mental Health Act, but only for psychiatric treatment