skip to main content

Advance Decision Refusal — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

HardMedicolegal & EthicsAdvance Decision RefusalFRCA Final

A 72-year-old man in England is admitted with acute hypercapnic respiratory failure. He is drowsy and, on decision-specific assessment, lacks capacity to decide about tracheal intubation. Three years ago he appointed his wife as health and welfare attorney, expressly authorising her to make decisions about life-sustaining treatment. Two years ago, while he had capacity, he made a written, signed and witnessed advance decision to refuse treatment. It specifically refuses invasive ventilation, including endotracheal intubation, in these circumstances and states that the refusal applies even if his life is at risk. There is no evidence of withdrawal, inconsistent conduct or a later lasting power of attorney, and the clinical team is satisfied that the decision is valid and applicable. His wife requests intubation. What is the legally correct action?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Do not intubate; follow the later valid and applicable advance decision

Explanation lettering: C = shown as A · D = shown as B · E = shown as C · A = shown as D · B = shown as E

B is correct. In England, a valid and applicable ADRT has the same effect as a contemporaneous refusal by a person with capacity. The required formalities for refusing life-sustaining treatment are met, including the explicit statement that the refusal applies even if life is at risk. Because the ADRT post-dates the health and welfare LPA, it overrides the attorney's contrary request. Best-interests authority therefore cannot justify intubation, excluding D. The Court of Protection may determine whether an ADRT exists or is valid and applicable, but cannot override one that is valid and applicable, excluding C. An ADRT operates when the person lacks decision-specific capacity; unconsciousness is not required, excluding E. Other clinically appropriate treatment not refused by the ADRT, including symptom relief and potentially non-invasive support if outside its scope, should continue.

Reference: Mental Capacity Act 2005 Code of Practice, Chapter 9, paragraphs 9.24, 9.33–9.36, 9.41 and 9.52, 2007. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/497253/Mental-capacity-act-code-of-practice.pdf