Which Treatments Can You Refuse in an Advance Directive in Wales?

What You Can Refuse

Under the Mental Capacity Act 2005, an ADRT lets you refuse any medical treatment — there is no exclusion list. The only requirement is that you name the treatment specifically and describe the circumstances under which the refusal applies.

The treatments most commonly refused in ADRTs:

Cardiopulmonary resuscitation (CPR): Chest compressions, defibrillation, intubation, and mechanical ventilation during a cardiac or respiratory arrest. For elderly patients with serious comorbidities, survival rates after out-of-hospital cardiac arrest are low, and survivors frequently sustain rib fractures, brain injury, and prolonged ICU stays.

Invasive mechanical ventilation: Connection to a breathing machine via endotracheal tube, typically in an intensive care unit. This can sustain biological life for weeks or months, even when meaningful recovery is impossible.

Clinically assisted nutrition and hydration (CANH): Artificial feeding and fluids through a nasogastric tube (through the nose) or a PEG tube (surgically inserted into the stomach). This is often the treatment that sustains life longest after consciousness is permanently lost. Refusing CANH is legal but must be explicitly stated — courts have examined this refusal more closely than most others.

Dialysis: Kidney dialysis in patients with end-stage renal failure. Without it, serious complications can develop and death can follow.

Antibiotics (IV or oral): Refusing antibiotics for life-threatening infections — particularly relevant for patients with terminal conditions where treating an infection would extend the dying process.

Blood transfusions: Commonly refused for religious reasons (Jehovah's Witnesses) but can be refused by anyone for any reason.

Chemotherapy or radiotherapy: Refusing specific cancer treatments under defined circumstances — for example, "I refuse further chemotherapy if my oncologist confirms the cancer is no longer responsive to treatment."

What You Cannot Refuse or Request

An ADRT has two hard boundaries:

1. You cannot request a specific treatment. An ADRT is a refusal tool only. You can refuse ventilation, but you cannot demand palliative sedation. Treatment requests go in an Advance Statement (advisory, not binding) or are handled by your Health and Welfare LPA attorney.

2. You cannot refuse basic nursing care. Washing, repositioning, oral hygiene, and comfort measures are not "treatment" under the Act. A clinician has a duty of care to provide basic nursing regardless of any ADRT.

You also cannot use an ADRT to request anything illegal — assisted suicide or euthanasia are not lawful in England and Wales, and no ADRT can change that.

How to Word Each Refusal

The difference between an enforceable ADRT and a useless one is specificity. Compare:

❌ "I do not want to be kept alive by machines." ✅ "I refuse invasive mechanical ventilation if I am diagnosed with advanced, irreversible dementia and I am unable to recognise close family members."

❌ "No heroic measures." ✅ "I refuse cardiopulmonary resuscitation if I have a terminal illness with a prognosis of six months or less."

❌ "Don't let me suffer." ✅ "I refuse clinically assisted nutrition and hydration if I am in a persistent vegetative state or minimally conscious state, as confirmed by two independent neurological assessments."

Each refusal clause should name:

• The specific treatment being refused (clinical terminology preferred)
• The medical circumstances under which the refusal applies (diagnosis, prognosis, or clinical state)
• The life-sustaining declaration ("even if my life is at risk or may be shortened as a result") if the treatment could keep you alive

Refusing Chemotherapy Without Refusing All Cancer Treatment

This is a common concern. You may want to refuse aggressive chemotherapy if it's no longer effective but keep palliative radiotherapy for pain management. An ADRT handles this with conditional refusals:

"I refuse systemic chemotherapy if my oncologist confirms that the treatment is no longer achieving disease control, defined as progressive disease on two consecutive assessments. I do not refuse palliative radiotherapy administered solely for symptom relief."

The key is clinical precision. "No more chemo" is too vague. A refusal tied to a specific clinical outcome (progressive disease despite treatment) gives the oncologist a clear decision point.

The Life-Sustaining Treatment Declaration

Any refusal of a treatment that could sustain your life — CPR, ventilation, CANH, dialysis, IV antibiotics during a life-threatening infection — requires the written statement: "even if my life is at risk or may be shortened as a result."

This declaration is a required part of making a life-sustaining refusal legally binding. Without it, a refusal of CPR or ventilation is not valid for those refusals, and the clinician must make a best-interests decision.

Our Wales ADRT planning guide includes pre-drafted refusal clauses for seven treatment categories, each with the correct clinical terminology and circumstantial triggers. The templates are designed for the Welsh clinical context, cross-referenced to NHS Wales terminology and compatible with the All Wales ADRT form.

Get the complete planning kit and turn your treatment preferences into enforceable legal refusals.

See more Wales guides →