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ADRT Legal Framework — SCE Medical Oncology MCQ

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HardSupportive & Palliative OncologyADRT Legal FrameworkSCE Medical Oncology

A capacitous adult types an ADRT refusing invasive ventilation if advanced cancer causes irreversible respiratory failure. It names the circumstances and says the refusal applies even if life is at risk, but it is neither signed nor witnessed. She later loses capacity. What is its legal status?

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

Reveal the answer and explanation

Correct answer: A — It is not a binding refusal of life-sustaining treatment because signature and witnessing are required

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

E is correct. An ADRT concerning life-sustaining treatment must be in writing, signed by the maker or at their direction in their presence, witnessed, and state that it applies even if life is at risk. This document lacks signature and witnessing, so it is not a binding refusal, although it remains important evidence of wishes in a best-interests decision. A removes mandatory formalities. B cannot retrospectively validate the document by family confirmation. C misunderstands the purpose of advance refusal. D wrongly makes an LPA the only advance-planning route. Clinicians should verify applicability and validity rather than treating every written preference as a binding ADRT.

Reference: NHS advance decision to refuse treatment guidance: https://www.nhs.uk/tests-and-treatments/end-of-life-care/planning-ahead/advance-decision-to-refuse-treatment/