Everyone has the right to make healthcare decisions for themselves (ie: consent or refuse medical treatments or interventions) if the person is a competent adult. However, when a person lacks capacity (ie: becomes unable to make or communicate your decisions), the doctors in charge will make decisions for the patient based on his/her best interest. In such cases, the principle of sanctity of life prevails – which means doctors will do whatever it takes to preserve your life.
While doctors try to make decisions based on what they think is best for you, there is no guarantee that the decision is in fact what you actually wanted. For example, some people would rather die than being artificially kept alive when they are in a permanent vegetative state and there is no prospect of recovery.
An advance decision to refuse treatment (“ADRT”) is a legally binding statement regarding refusal to specific medical treatments in the event of one lacks capacity. In other words, you may make an advanced decision now to refuse a specific treatment/care at some time in the future.
Why Plan Ahead?
…ONLY YOU KNOW WHAT IS BEST FOR YOU…
Writing an advance decision can be a good way to start conversations with your family about what you would want in your future care, should you lack capacity to decide in the future. Recording your wishes in a legally enforceable way gives you control over your future treatment and care, and reassurance that your decisions will be respected. Sometimes, there can be disagreements among family members and doctors about what is “best” for you, your advance decision now can prevent unnecessary arguments or disputes from happening in the future.
Be Careful in Making an ADRT
You may want to refuse a specific treatment in some situations but not others. Therefore, you need to think carefully and be very clear about all the circumstances in which you want to refuse treatments. We hereby provide you with a sample advance decision for your reference.
Advance Decision to Refuse Treatment (SAMPLE only)
This Advance Decision to Refuse Treatment shall be a legally binding document which sets out the situations in which I want to refuse medical treatment(s) should I lack capacity to make or communicate that decision(s) in the future. I have carefully considered these decisions and I confirm that I have capacity to make them. I understand that decisions about my diagnosis and prognosis will be made by the doctor(s) in charge of my care.
My Personal Information:
Name: __________________________________
Address: __________________________________
Date of Birth: __________________________________
NRIC No: __________________________________
I have discussed this advance decision with _______________________________________
___________________________________________________________________________
___________________________________________________________________________
Advance Statement
This statement explains why I am making this Advance Decision and why is it important to me in relation to my health, care, and quality of life.
(Here you can include anything that is important to your health and wellbeing. Write about why you are making this Advance Decision, or the things that are important to your quality of life, values or beliefs. The things you write here are important because they must be considered when someone is making a decision for you, so that the ultimate decision will accord to your wishes and will be in your best interests.)
I hereby confirm that the following refusal(s) of treatment are to apply even if my life is at risk or may be shortened as a result.
My refusals of treatment:
I refuse ALL life-sustaining treatment if:
- I have been diagnosed with any of the conditions I have included/ticked below, and
- I can no longer make or communicate decisions about my medical treatment, and
- I am unlikely to regain the ability to make these decisions.
** I understand that life-sustaining treatment includes but is not limited to CPR, clinically assisted nutrition and hydration, artificial or mechanical ventilation and antibiotics for life threatening infections.
| Conditions | Include (please tick ) | DO NOT include
(please tick) |
| (A) Any type of dementia
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| (B) Brain injury
* I understand that brain injury includes but is not limited to stroke, permanent vegetative state and minimally conscious state.
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| (C) Diseases of the central nervous system
* I understand that a disease of the central nervous system includes but is not limited to motor neurone disease, Parkinson’s Disease and Huntington’s Disease.
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| (D) Terminal illness
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| (E) Refusing treatment in other situations, eg:
(you may state according to your own wish)
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For the avoidance of doubt: (tick all that apply)
| Conditions | Include (please tick ) | DO NOT include
(please tick) |
| Pain Relief
* I wish to be given all medical treatment intended to alleviate pain or distress, or aimed at ensuring my comfort.
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| Pregnancy
*If I am pregnant, I wish to receive medical treatment or procedures leading to the safe delivery of my child. Once my child is safely delivered I wish to reinstate my wishes as set out in the statement above.
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| Organ donation
* I am on the Organ Donor Register.
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I would like the following people to be involved in deciding my care should I lose the capacity to do so:
Name: _______________________ Name: _______________________
Email: _______________________ Email: _______________________
Phone Number: _______________________ Phone Number: _______________________
Relationship: _______________________ Relationship: _______________________
Signature
I confirm that I have carefully considered my wishes as set out above, and all the decisions are made by myself voluntarily according to my own wishes and belief, without any undue influence or duress by any parties.
(your signature)
________________
Name:
NRIC No:
Date:
Witnesses
I confirm that this Advance Decision is made by (your name), and is signed voluntarily in my presence, and (your name) is of sound mind at the time of signing this advance decision.
(witness 1’s signature)
_____________________
Name:
NRIC No:
Date:
(witness 2’s signature)
______________________
Name:
NRIC No:
Date:
YOU MAY DOWNLOAD THE ADVANCE DECISION SAMPLE BELOW!!
