Advance Decisions to Refuse Treatment (ADRT)

08 February 2016

Jenny Kitzinger

Action needed to improve understanding and take-up in Wales

Action is needed to inform and boost the number of people in Wales who make Advance Decisions to Refuse Treatment (ADRT), according to a new report.

An ‘Advance Decision’ is a legally binding record of the treatments that someone wishes to refuse should they lose the ability to make such decisions for themselves in the future.

This can include, for example, refusing life-sustaining treatment if you are diagnosed as being in a permanent vegetative state as a result of a car accident or illness.

Currently Wales lags behind England and other European countries with just 2% of people in Wales making an ADRT.

The report, produced by the Public Policy Institute for Wales (PPIW), highlights a number of actions which the Welsh Government, along with charities and other organisations, could take to ensure people understand their options for advance care planning and that their right to refuse treatment.

Professor Jenny Kitzinger from the School of Journalism, Media and Cultural Studies who co-authored the report said: “Some people feel very passionately that they would not want particular medical interventions under certain circumstances – it is important they know how to safeguard their choices.

“There is a wide spread myth that ‘next of kin’ can refuse treatment on your behalf if you lose the capacity to make decisions at the time, but this isn’t true.

“Unless you take action, the decision defaults to doctors acting in your ‘best interests’. Some people are happy with that situation, but some people are not.

“The Mental Capacity Act 2005 made it possible to protect your own choices in advance – it is important that people understand their options.”

The report makes a number of key recommendations.

They include: increasing awareness of ADRTs in Wales through public education and media engagement; normalising ADRTs; practitioner training; and the creation of an All-Wales national repository which will flag key emergency decisions and ensure accessibility of full ADRT documentation.

The report, Increasing understanding and uptake of Advance Decisions in Wales, is available on the Public Policy Institute for Wales’ website