Advance Decisions to Refuse Treatment under the Mental Capacity Act 2005 (England & Wales): Do the Provisions Serve to Strengthen Patient Autonomy or Enable its Vulnerability In Law to Be Maintained?

In England and Wales, under the provisions of the Mental Capacity Act (MCA) 2005, the competent adult’s right to refuse future treatment has been placed onto a statutory footing in the form of Advance Decisions to Refuse Treatment (ADRTs).Two legal principles that are relevant to advance decisions involving refusals of life-sustaining treatment are (i) the sanctity of life and (ii) autonomy. These 2 principles may often come into conflict when competent adults make contemporaneous or advance refusals of life-sustaining medical treatment. Historically, the principle of sanctity of life has often prevailed in these circumstances, trumping the principle of personal autonomy. Our objective was to test whether or not patient autonomy has been strengthened by the statutory provisions of the MCA in relation to ADRTs.