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by Dr Lisa Williams and
Dr John Rigby
Last updated: July 2016
'Advance directives' or 'living wills' were
originally designed for terminally ill patients. They are now seen
as increasingly relevant to psychiatry, where self-determination
has been recognised as a fundamental ethical principle.
Following the implementation of the Mental Capacity Act 2005,
there are two sorts of advance decisions – advance statements and
Advance Decisions to Refuse Treatment (ADRTs).
These anticipate a time when the capacity to make a treatment
decision has been lost, and detail a person’s wishes for future
medical treatment. As such, they are a way of enhancing patient
autonomy and choice.
As advance treatment refusals become more commonplace in
clinical practice, psychiatrists may well be called upon to give an
opinion about a person’s capacity to make an ADRT or be presented
with one by a patient. Thus, they need to feel confident in this
Start the module
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Download take-home notes to print and
This module will:
NB: This module covers advance decisions in
England and Wales only. For Ireland, please see the
module Advance directives in
Advance statements and the law in Scotland will
also be published soon.