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Advance Care Planning — SCE Medical Oncology MCQ

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HardSupportive & Palliative OncologyAdvance Care PlanningSCE Medical Oncology

A patient with metastatic cancer has capacity and wants a refusal of invasive ventilation to remain binding if they later lose capacity. Which document and formal requirement are most relevant in England and Wales?

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Correct answer: BA valid and applicable ADRT meeting the formalities for refusing life-sustaining treatment

An advance decision to refuse treatment can be legally binding when it is valid and applicable. Refusal of life-sustaining treatment has additional formal requirements: it must be written, signed and witnessed and explicitly apply even if life is at risk. An advance statement informs best-interests decisions but is not itself binding; DNACPR concerns CPR rather than all ceilings of treatment, and relatives cannot replace a capacitous person’s decision without the relevant legal authority.

Reference: NICE NG108 decision-making and mental capacity (Published October 2018): https://www.nice.org.uk/guidance/NG108/chapter/recommendations