ADRT is the decision to refuse a specific type of treatment at some point in the future. Patients can refuse any kind of treatment, including those which are life-sustaining (e.g., CPR, ventilation and antibiotics).
Making an ADRT decision
- An ADRT decision is made by the patient, as long as they are:
- aged 18 or over
- have mental capacity (as per Mental Capacity Act)
- This decision must be made in writing, via an ADRT form ⬇️
Patient resources
- Age UK - Living Wills
- Healthtalk.org - videos and written interviews of people talking about making an advance decision
- Macmillan: Advance decision to refuse treatment
Making a DNACPR decision
DNACPR means that if a patients heart or breathing stops, we (as their healthcare team) will not try to restart it.
❗This refers to CPR only. It does NOT mean that other care and treatment will not be provided.
In advance
- A patient can decide, in advance, to refuse CPR. The decision can be made at any time, regardless of health (i.e., for instance, if a patient is healthy or are receiving palliative/end-of-life care).
- If a patient changes their mind, they must let their doctor know so that their records can be changed
Patients will be asked about their CPR status as part of a Palliative Care review.
- A doctor can also make this decision, in advance, if they have reason to believe that CPR would not be suitable for the patient (for instance, if it would cause more harm)
- A DNACPR decision must be made on an individual basis, and should be based on the patients health, needs and priorities.
- Whilst patient consent is not a requirement here, you should do your best to:
- Address the topic sensitively with the patient. Open a discussion with the aim of reaching a shared understanding with the patient about their situation, your judgement, and your reasons for reaching it. Be sure to listen to the patient’s wishes and preferences, and encourage them to ask you questions.
- Do NOT force a patient to discuss a DNACPR decision. Instead, seek their permission to have a conversation with their family, friends and/or carers to discuss how they can best support the patient.
If this decision is made, a DNACPR and ADRT form must be completed. Provide the patient with a copy, and advise them to keep it in an easy to find place (e.g., fridge door, carers folder).
- DNACPR Form: can be found on EMIS by searching ‘DNACPR Form For Adults’.
- ADRT Form: see above
Unable to make decision in advance
If a patient lacks capacity to make a DNACPR decision, a GP should check if the patient has an ADRT. If they do not, you should consult with any legal proxy and others close to the patient about the DNACPR decision (where appropriate). Initiate these discussions as early as possible, and please make sure that you sensitively and clearly explain that the intention of the DNACPR is to spare the patient treatment that will be of no benefit (not to withhold care or treatment).