A look at Salford's ADRT card scheme...
Over the last month, Salford City Council in Greater Manchester has been promoting cards announcing 'Advance Decisions to Refuse Treatment'. Christened 'ADRTs' by the media, the small wallet-sized cards feature a prominent cartoon bubble saying 'Stop' and are attached to an explanatory leaflet. They are being promoted extensively in pubs, libraries and GP surgeries. Salford Council says that these cards simply reflect its statutory obligation to respond to the Mental Capacity Act, which came into force in October last year.
Patients have a right to be involved as much as possible in decisions about their own treatment and care. Advance directives, previously known as 'living wills', are attempts to extend the decision-making capacity of autonomous patients into a period when they may have lost capacity to express their wishes. For example, a patient who suddenly has a stroke may no longer be able to communicate his or her long-held wish not to be resuscitated. As a safeguard against abuse, advance refusals of life-sustaining treatment must now be written, signed and witnessed. Only refusals can be made as no patient can insist in advance that they receive any particular treatment.
However, individual autonomy must have limits, set in ethics and law, for the protection of others in the complex inter-related society we live in. One historic concern has been the promotion of ADRTs by various 'right-to-die' bodies around the world, with the campaign objective of securing suicidally-ideated advance directives: once patients who have refused, say, food and fluids, are seen to be suffering pointlessly for days or weeks before they die, then legalising a lethal injection earlier in that process is likely to be achieved.
For this reason and for the many practical reasons below, there are strong arguments against ADRTs being granted the force of statute law. Valid and applicable ADRTs do now have such force, under the Mental Capacity Act which does contain some protection against the 'back door route into euthanasia', namely:
There is a real concern that ADRTs could become a back door route into euthanasia. We note the strong support of Dignity in Dying (formerly the Voluntary Euthanasia Society) for this Salford initiative and repeat our continuing opposition to intentionally ending the lives of our patients by commission or by omission.