End of life care: Assessing the applicability of advance refusals

1. 71. In relation to judgements about applicability, the following considerations apply across the UK:

1. (a) whether the decision is clearly applicable to the patient’s current circumstances, clinical situation and the particular treatment or treatments about which a decision is needed
2. (b) whether the decision specifies particular circumstances in which the refusal of treatment should not apply
3. (c) how long ago the decision was made and whether it has been reviewed or updated (this may also be a factor in assessing validity)
4. (d) whether there are reasonable grounds for believing that circumstances exist which the patient did not anticipate and which would have affected their decision if anticipated, for example any relevant clinical developments or changes in the patient’s personal circumstances since the decision was made.