Advance decision to refuse treatment

An advance decision to refuse treatment (ADRT) is a written statement by which a person with capacity sets out, in advance, specific medical treatments they wish to refuse if they later lose the capacity to make the decision themselves. It is a creature of statute in England and Wales: sections 24–26 of the Mental Capacity Act 2005 make a valid and applicable ADRT legally binding on healthcare professionals, who must follow it even where they consider treatment would be in the person's best interests. [source: legislation-gov-uk/mental-capacity-act-2005-2026-05-02.html]

Validity: the person must have had capacity when the ADRT was made; must have made it voluntarily; must not have withdrawn it; and must not have done anything since that suggests a change of mind. Applicability: the medical situation must match the one described in the document, and the person must currently lack the capacity to make the decision. [source: nhs-uk/advance-decision-to-refuse-treatment-2026-05-02.html]

Refusing life-sustaining treatment has stricter formalities. The ADRT must be in writing, signed by the person in front of an adult witness, include a clear statement that it applies "even if my life is at risk," and be signed by the witness in the person's presence. Without these formalities, an attempt to refuse life-sustaining treatment in advance is invalid. Refusals of treatment that are not life-sustaining can be made informally, though writing them down is strongly advised. [source: legislation-gov-uk/mental-capacity-act-2005-2026-05-02.html]

Scotland and Northern Ireland do not have an equivalent statutory framework. In Scotland, advance statements are recognised at common law and in clinical practice (the Adults with Incapacity (Scotland) Act 2000 governs decision-making for those who lack capacity but does not codify advance refusals). In Northern Ireland, the partially-commenced Mental Capacity Act (Northern Ireland) 2016 will eventually cover the area; for now, advance decisions are governed by common law and in practice are followed where valid and applicable.

Limits: an ADRT can only refuse treatment, not request it, and cannot refuse basic care (warmth, hygiene, comfort measures, pain relief). It cannot override mental-health treatment compulsorily authorised under the Mental Health Act 1983. A health-and-welfare LPA made after an ADRT, with explicit authority over the same treatment, can override the ADRT — earlier LPAs cannot.

→ Advance decisions and living wills

AfterLoss

See how AfterLoss handles planning mode for where an advance decision sits alongside other end-of-life paperwork.

Last verified: 2 May 2026 against nhs.uk advance decision guidance and the Mental Capacity Act 2005, ss.24–26.