Increasing Understanding and Uptake of Advance Decisions to Refuse Treatment in Wales – report published

A report has just been published by the Public Policy Institute for Wales for the Welsh Minister for Health and Social Services on how to increase the understanding and uptake of ADRTs in Wales.  Written by Professors Jenny and Celia Kitzinger, it identifies barriers to the uptake of ADRTs including: misunderstanding about what is involved; scepticism about whether the patient’s wishes will be respected; and the mistaken belief that an ADRT is unnecessary if someone has already informed family members or healthcare professionals of what they would want.

The report highlights a number of actions which the Welsh Government, along with charities and other organisations, should take to ensure people understand their options for advance care planning, and that their right to refuse treatment, if they so wish, is respected. These include:

  • Public education, media engagement and cultural events to encourage people to plan for potential future loss of capacity;
  • De-bunking the myth that ‘next of kin’ have decision-making powers and correcting official forms that may mislead people about the legal status of their own or a relative’s expressed wishes;
  • Facilitating access to well designed ADRT forms/guidance and skilled support, both for the general population and for particular groups;
  • Normalising ADRTs (e.g. offering registration when patients sign up with a GP);
  • Training relevant practitioners to ensure that they understand what ADRTs are (and when they are valid and applicable), are able to provide appropriate guidance or referral, and can act in accordance with the law concerning them;
  • Creating an All-Wales national repository – flagging key emergency decisions and ensuring accessibility of full ADRT documentation.

The report serves as an extremely useful review of the position of ADRTs both in law and in practice.   As Tor Butler-Cole very rightly says, greater awareness of ADRTs is a good thing.  We can but hope that the recommendations (particularly, for my part, the creation of a national registry) are taken forward by Welsh Government, not least to spur/shame England into action.


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