QuestionSBA
QuestionChoice
These are professionals who are consulted with to make best interest decisions, once a patient has already lost capacity and often if they lack family members/friends to aid with the best interest decision.
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c
Consulting with an independent mental capacity advocate
QuestionChoice
This a document in which a patient can express preferences for treatments they do want to have, if they are no longer able to make decisions for themselves. It is **not** legally binding.
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b
An advance statement
QuestionChoice
To refuse life sustaining treatment, an advance decision needs to be drawn up. This needs to clearly state which treatments are to be refused with acknowledgement of these being life sustaining treatments. They also need to be written, signed and witnessed.
10017199
d
Telling the doctor verbally that they do not want to be intubated, if they were to lose capacity in future
QuestionChoice
An advance decision to refuse treatment is a way that people with capacity can establish which treatments they do not want in the future, were they to lose capacity. If patients wish to refuse life-sustaining treatments, the advance decisions need to be written down clearly stating what is to be refused, and must be signed and witnessed.
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a
An advance decision to refuse treatment
QuestionChoice
This is incorrect, as advance decisions allow this to be done.
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e
It is not possible to refuse future treatments in a way which is legally binding
QuestionComment
advanced "directive" please.
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QuestionComment
Advanced decision to refuse treatment  (ADRT) is the correct official term. It is also known as an advanced directive.
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Suture Jargon
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# Overview

The Mental Capacity Act (MCA) includes provisions that allow people to plan for their care in advance, for a situation in the future where they do not have the capacity to make decisions. Two of these are Advanced Statements and Advanced Decisions. An individual can make both an Advanced Statement and an Advance Decision.

# Definition of Advanced Decisions

An Advanced Decision, short for Advanced Decision to Refuse Treatment, is a legally binding document. Its purpose is to ensure that an individual can refuse a specific treatment(s) that they do not want to have in the future.

# Advanced Decision Criteria

In order for an Advanced Decision to be legally binding, it must meet certain criteria:

​ _It must be valid (this means it must have been made at a time when the individual had capacity to make that decision)._

​ _It must be applicable (this means the wording must be specific to the medical circumstances, and not vague or unclear)._

​ _It must have been made when the individual was over 18, and fully informed about their decision._

​ _It must not have been made under the influence or duress of other people_

​ _It must be written down, be signed and witnessed (if it concerns a refusal of life-saving treatment)_

# What Can Advanced Decisions Cover?

Treatments that can be refused include life-sustaining treatments. It cannot refuse basic care (such as washing), food or drink by mouth, measures designed purely for comfort (e.g. painkillers), or treatment for a mental health condition if the individual is sectioned under the Mental Health Act. It can also not demand specific treatment or something that is illegal (e.g. assisted dying).

# Definition of Advanced Statement

An Advance Statement is sometimes called a "Statement of Wishes and Care Preferences". It allows an individual to make general statements about their wishes, beliefs, feelings and values and how these influence their preferences for their future care and treatment.

An Advance Statement is not by itself legally binding, but legally must be taken into consideration when making a "best interests" decision on someone's behalf under the Mental Capacity Act (MCA), 2005. This is because one of the criteria of the MCA is that a patient's "wishes, feelings, beliefs and values" must be taken into consideration; an Advanced Statement provides evidence of this.

# Advanced Statement information included

Information that can be included in an Advanced Statement can be anything that is important to the individual. This might include:

​ _Religious or spiritual views, and those that might relate to care_

​ _Food preferences_

​ _Information about your daily routine_
​ _Where you would like to be cared for (in hospital, at home, in a care home etc.)_

​ _Any people who you would like to be consulted when best interests decisions are being made on your behalf (however this does not give the same legal power as creating a Lasting Power of Attorney)_

# What Can Advanced Statement Cover?

An Advanced Statement can be made verbally, but it is better to write it down so there is clear documented evidence of an individual's wishes and views. Copies of the Advanced Statement can be given to anyone the individual wishes to have a copy (e.g. their GP, carers and relatives).
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Distinguishing between Advanced Statements and Advanced Decisions
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Ethics and Law
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An advance decision to refuse treatment allows individuals to specify unwanted medical interventions in the event they lose decision-making capacity.
A 45-year-old male with motor neuron disease would like to find out if it is possible to establish which medical treatments they do not want to have in future, if they were no longer able to make these decisions for themselves.

How can they do this in a way which is legally binding?
a