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Caring for a patient who has made an advance decision to refuse treatment


This case study supports the information on Mental capacity in the Ethical Hub. It aims to help explain how certain principles in our guidance should be applied to patients and in practice.

  • Each case study begins with the patient’s notes to set the scene and the characters
  • The grey boxes tell the story
  • The blue boxes summarise the doctor’s considerations and/or actions
  • At the end of each case study we highlight the paragraphs in our guidance for your reference


James Lang lives in a care home and has a diagnosis of vascular dementia which has deteriorated.  

Two year ago he made an advance decision to refuse treatment (ADRT) about his the eye tumour. He was aware this tumour may eventually lead to his death. 

Dr Pires, has been contacted by the care home. They have concerns that James’ affected eye is bulging.  They are also concerned as he has been coughing up green phlegm and has not eaten in 24 hours.  


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