Advance decision (ADRT) & LPA
What it means
An ADVANCE DECISION TO REFUSE TREATMENT lets a capacitous adult REFUSE specified future treatment for when they lose capacity; it is legally BINDING if valid and applicable (must be written, signed, witnessed and specify 'even if life is at risk' to refuse life-sustaining treatment). A LASTING POWER OF ATTORNEY (health & welfare) lets a person appoint someone to make health decisions when they lose capacity — an LPA can consent/refuse on their behalf within its scope.
Worked example
A man with a valid ADRT refusing ventilation 'even if my life is at risk' cannot be ventilated when he later loses capacity — the binding refusal overrides best-interests arguments.
In the exam
An incapacitous patient has a previously written, signed and witnessed document refusing life-sustaining ventilation; the team must follow it.
What settles it
An ADRT can only REFUSE (not demand) treatment; to refuse LIFE-SUSTAINING treatment it must be written, witnessed and explicitly state it applies even if life is at risk.
Classically confused with
Best interests
Source: MCA 2005