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A new statutory right for patients to say in advance what treatments they would want to refuse if they later lose the capacity to take decisions came into force this week.
Doctors will have to abide by the new advance decisions to refuse treatment (ADRTs) or risk criminal or civil proceedings in the courts.
The measure forms part of the Mental Capacity Act 2005, which from October 1 also gives individuals the right to create a lasting power of attorney by appointing a trusted friend or relative to take healthcare decisions for them in the event that they become incapacitated.
Advance directives or “living wills” to refuse treatments are already binding under common law, but the act sets up a statutory framework that aims to give doctors and patients greater certainty.
Patients will not be able to demand any particular treatment or require a doctor to do anything unlawful. NHS guidance on ADRTs says it should be made clear to a patient that artificial nutrition and hydration are considered treatment, while basic care, such as giving food and water by normal means, is not.
An ADRT can be oral or written but if it is refusing life sustaining treatment, the law requires it to be in writing, signed and witnessed, and to include a statement that it is to apply even when life is at risk.
Ben Lobo, a consultant physician and community geriatrician who chairs the East Midlands ADRT Project Team and has been asked to help produce national guidance, said, “A valid advance decision has to be respected and acted upon by anybody including doctors, nurses, and ambulance staff. This new law will help to reduce stressful discussions between professionals and carers in times of medical crisis when the patient might be too ill to tell people. It will help people to die with dignity on their own terms.”
Paul Farmer, chief executive of the mental health charity Mind, said, “The Mental Capacity Act is an important development, introducing new safeguards to protect the rights of some of the most vulnerable people in our society. It gives people with mental health problems more control over their lives, so that they can choose how they are treated if they are unable to make decisions in the future.”
Guidance on ADRTs is available on the BMA's website and at www.adrtnhs.co.uk.