[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-488906-105":59,"doc-detail-488906-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","advance-decision-to-refuse-treatment-version-3","Advance decision to refuse treatment - Version 3","","Advance decision pack for refusing medical treatment when a person lacks mental capacity to make or communicate decisions in the future. Includes a one-page cover sheet for GPs, guidance on when advance decisions apply, and options to order a wallet-sized “Notice of advance decision” card. The form records personal details, GP information, specific refusals including life-sustaining treatment for defined conditions, symptom management preferences, pregnancy wishes, reasons, lasting power of attorney, contacts, signatures, witnesses, and review dates. Legal status in England and Wales under the Mental Capacity Act 2005 is emphasized.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/advance-decision-to-refuse-treatment-version-3/488906/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/advance-decision-to-refuse-treatment-version-3/488906.png","ImageObject",300,407,{"name":92,"@type":93},"Lucas Martin","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-04","2026-10-01",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"When does this advance decision to refuse treatment apply?","Question",{"text":113,"@type":114},"It applies when a decision needs to be made about treatment and the person does not have mental capacity to decide or communicate that decision in the future.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What kinds of life-sustaining treatment can be refused?",{"text":118,"@type":114},"The form states that life-sustaining treatment includes but is not limited to CPR, clinically assisted nutrition and hydration, artificial or mechanical ventilation, haemodialysis, haemofiltration, and antibiotics for life-threatening infections.",{"name":120,"@type":111,"acceptedAnswer":121},"How often should the advance decision be reviewed?",{"text":122,"@type":114},"The form recommends reviewing decisions every two years, or sooner if health or circumstances change, and confirming the document reflects current wishes.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},488906,1791304554,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":146,"preview_page_count":4},8796095360427,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Advance decision pack  \nYour document contains:  \n Advance decision to refuse treatment  \nThis form sets out the situations in which you want to refuse medical treatment if you are unable to make or communicate that decision in the future.  \n Information for GPs  \nA one page cover sheet for you to give to your GP along with your form.  \n Guidance notes  \nThis gives information to help you complete your form.  \nThe notes explain when an advance decision would be used and offers support to consider your wishes.  \nYou can contact us to order a wallet-sized ‘Notice of advance decision’ card. This explains that you have made an advance decision and where a copy can be found.  \nTo order a card contact us on:  \n 0800 999 2434  \n [info@compassionindying.org.uk](info@compassionindying.org.uk)  \nThis page is intentionally blank.  \nAdvance decision to refuse treatment  \nThis advance decision to refuse treatment sets out the situations in which I want to refuse medical treatment should I lack mental capacity to make or communicate that decision in the future. I have carefully considered these decisions and I confirm that I have mental capacity to make them. I understand that decisions about potential diagnosis and prognosis will be made by the doctor in charge of my care.  \nNeed help filling this in?  \nIf you have any questions, you can contact Compassion in Dying’s Information Line on:  \n 0800 999 2434  \n [info@compassionindying.org.uk](info@compassionindying.org.uk)  \nThere are guidance notes to help complete this form. For a copy, contact Compassion in Dying.  \n1. About me  \nName:  \nAddress:  \n\n| Date of birth: |\n| --- |\n| NHS number: |\n\n2. GP details  \nName:  \n\n| Surgery: |\n| --- |\n| Address: |\n\nPhone number:  \n3. My refusals of treatment  \nI 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.  \nI refuse all life-sustaining treatment if:  \n• I have been diagnosed with any of the conditions I have included in (A) to (D) below, and  \n• I can no longer make or communicate decisions about my medical treatment  \nI understand life-sustaining treatment includes but is not limited to cardiopulmonary resuscitation (CPR), clinically assisted nutrition and hydration, artificial or mechanical ventilation, haemodialysis, hemofiltration and antibiotics for life-threatening infections.  \n\n| (A) Any type of dementia | Tick to include  |\n| --- | --- |\n| (B) Brain injury\u003Cbr>I understand that brain injury includes but is not limited to stroke and prolonged disorders of consciousness. | Tick to include  |\n| (C) Progressive neurological conditions\u003Cbr>I understand that a progressive neurological condition is a disease affecting the brain, spinal cord or nervous system that causes neurological function to deteriorate over time. Examples include but are not limited to motor neurone disease, Parkinson’s disease, Huntington’s disease and multiple sclerosis. | Tick to include  |\n| (D) Terminal illness | Tick to include  |\n\n(E) Refusing treatment in other situations  \nI refuse the following specific treatments: In these circumstances:  \nI have included additional pages for section 3.E and have attached them to this form   \n4. Symptom management  \nI understand that I will be given all appropriate treatment, medication and care aimed at relieving pain, managing symptoms, reducing distress and ensuring my comfort, as long this respects any valid and applicable refusals of treatment in section 3.E.  \n5. Pregnancy  \nIf 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 Iwish to reinstate my decisions as set out in this form.  \nTick to include   \n6. My reasons for making this advance decision  \nThis statement explains why I am making this advance decision and what is important to me in relation to my health, care, and quality of life.  \nI have included additional pages for section 6 and have attached them to ","cbCaijDLrykQRFre","https://ap.wps.com/l/cbCaijDLrykQRFre","pdf",394323,27,"English","# 1. About me\n# 2. GP details\n# 3. My refusals of treatment\n## (A) Any type of dementia\n## (B) Brain injury\n## (C) Progressive neurological conditions\n## (D) Terminal illness\n## (E) Refusing treatment in other situations\n# 4. Symptom management\n# 5. Pregnancy\n# 6. My reasons for making this advance decision\n# 7. Lasting power of attorney for health and welfare\n# 8. People to contact if I have lost mental capacity\n# 9. Signature and 10. Witness\n# 11. Review dates\n# Information for GPs and next steps","[{\"question\":\"When does this advance decision to refuse treatment apply?\",\"answer\":\"It applies when a decision needs to be made about treatment and the person does not have mental capacity to decide or communicate that decision in the future.\"},{\"question\":\"What kinds of life-sustaining treatment can be refused?\",\"answer\":\"The form states that life-sustaining treatment includes but is not limited to CPR, clinically assisted nutrition and hydration, artificial or mechanical ventilation, haemodialysis, haemofiltration, and antibiotics for life-threatening infections.\"},{\"question\":\"How often should the advance decision be reviewed?\",\"answer\":\"The form recommends reviewing decisions every two years, or sooner if health or circumstances change, and confirming the document reflects current wishes.\"}]","Advance decision to refuse treatment - Version 3 | PDF",1790818852,68]