Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Advance Care Planning :
ADRT - Advance Directive to Refuse Treatment
An Advance Directive to Refuse Treatment is a set of instructions setting out the specific circumstances in which an individual would:
not want certain treatments
want a particular treatment to be stopped.
Who can make an ADRT
An advance decision to refuse treatment can be made by anyone over 18 years old who has the mental capacity to do so.
In Scotland, an Advance Directive to Refuse Treatment can be made by anyone over the age of 16 who has the mental capacity to do so.
An ADRT can’t be used to refuse any basic care needed to keep the individual comfortable. This includes food, warmth, shelter, offers of food and fluids by mouth, and pain control.
It cannot be used to request that life be brought to an end.
ADRT and the law
In England and Wales an Advance Decision to Refuse Treatment is legally binding.
This means it must be followed by the healthcare team provided they know about it.
It must also meet certain criteria which are set out in the Mental Capacity Act (2005)|.
In Northern Ireland and in Scotland, an Advance Decision is legally binding although it is governed by common law instead of an Act, and similar criteria apply.
It must be followed by the healthcare team provided if they know about it.
There is no legislation on advance care directive in the Redpublic of Ireland.
ADRTs are currently governed by common law.
The Department of Health has published its General Scheme for Advance Directives – a proposed addition to the Assisted Decision-Making (Capacity) Bill 2013, but the legislation is not yet enacted.
It’s best to include the information below when writing an Advance Decision to Refuse Treatment.
Any advance decision that refuses life-sustaining treatment must contain all the information below.
Name, date of birth, address and any distinguishing features – in case the individual is unconscious or unable to communicate and healthcare professionals need to identify him/her.
The name, address and phone number of the individual's GP, and whether they have a copy of the ADRT.
A statement saying that the document should be used if the person is ever lack capacity to make decisions.
A statement of which treatment(s) are to be refused, and the circumstances in which the decision would apply.
The date the ADRT was created.
The person's signature (if it’s a written statement).
A dated signature of at least one witness (if it’s a written statement).
If it’s an includes a directive to refuse treatment that will keep the person alive, it must also include the statement, ‘I refuse this treatment even if my life is at risk as a result’.
Advance Directive to Refuse Treatment template
Template for the recording of Advance Decision to Refuse Treatment
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This topic is part of the Advance Care Planning domain of the
Comprehensive Geriatric Assessment
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Advance Care Planning is one of 8 domains of the
Comprehensive Geriatric Assessment (CGA)
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