PART 4: Refusal of Life-Saving Treatment, ADRT & LPA

PART 4: Refusal of Life-Saving Treatment, ADRT & LPA

• Core Dilemma: Managing a capacitous patient discharging against medical advice (DAMA), or verifying a Living Will (ADRT) or Power of Attorney (LPA) in an unconscious Resus patient.
• Capacitous DAMA Protocol: Never act punitively. Exclude reversible incapacity, solve practical domestic anxieties, document a verbatim 2-stage capacity assessment, involve a senior EM clinician, negotiate a harm-reduction compromise (e.g., oral meds, hot clinic follow-up), safety-net, and notify the GP.
• Advance Decisions to Refuse Treatment (ADRT — MCA ss.24–26): Valid only for makers aged 18+. To refuse life-sustaining treatment, an ADRT must be: (1) made by an 18+ adult with capacity, (2) in writing, (3) signed by the maker, (4) signed by a witness, and (5) explicitly state it applies "even if life is at risk." Under MCA s.26(3), if genuine doubt exists at 3:00 AM, resuscitate and stabilize while verifying the document.
• MRCEM/FRCEM Exam Trap: A Property & Financial Affairs LPA gives zero medical authority. A Health & Welfare LPA must be registered with the OPG and only covers life-sustaining treatment if Option A is explicitly ticked. Court-Appointed Deputies (MCA s.20(5)) can NEVER refuse life-sustaining treatment.