Does an Advance Decision need to be witnessed?

Yes. An Advance Decision refusing life-sustaining treatment must be signed by you, or by someone else at your direction, in the presence of a witness who also signs it.

Do I need a solicitor to make an Advance Decision?

No. A solicitor is not required, but legal advice can help ensure the document is clear, valid, and suitable for your circumstances.

Can I change or withdraw my Advance Decision?

Yes. You can withdraw an Advance Decision at any time while you have capacity, and the withdrawal does not usually need to be in writing.

Can a Lasting Power of Attorney override an Advance Decision?

A later Health and Welfare Lasting Power of Attorney may override an Advance Decision if it gives the attorney authority to make decisions about the same treatment.

When might an Advance Decision become invalid?

It may be treated as invalid if it conflicts with a later decision, such as making an LPA or acting in a way clearly inconsistent with the refusal.

Do healthcare professionals have to follow an Advance Decision?

Doctors must follow a valid and applicable Advance Decision. If there is doubt, they may provide treatment while assessing its legal effect.

Where should I keep my Advance Decision?

You should keep it accessible and share copies with your GP, healthcare team, family, attorneys, and anyone likely to be involved in your care.

How often should I review an Advance Decision?

No fixed renewal period applies, but reviewing it regularly helps show that it still reflects your current wishes and circumstances.

What is the difference between an Advance Decision and an advance statement?

An Advance Decision only refuses specified treatments. An advance statement records broader wishes, preferences, values, and care choices but is not legally binding in the same way.

Can I create an Advance Decision online?

Yes. You can use an online generator to draft an Advance Decision, but you should carefully check that it meets UK legal requirements and reflects your wishes.

EN-GB>Wills>Advance Decision>UK Advance Decision Validity Checklist

Advance Decision Validity And Applicability Checklist In The United Kingdom

Created: 8 Jun 2026

This checklist helps readers understand whether an advance decision may be valid and applicable under UK rules. It is useful for planning healthcare choices, reviewing legal requirements, and comparing related resources in AI Generated British Advance Decision.

Requirement	Explanation	Especially relevant to life sustaining treatment	Suggested action
Legal validity
Maker must be 18 or over	An Advance Decision can only be made by an adult.	false	Record the maker's full name, date of birth and address.
Capacity
Maker must have capacity when making it	A person cannot make a valid Advance Decision unless they can understand, retain, use or weigh the relevant information and communicate the decision.	true	Consider a capacity note from a GP or clinician for serious refusals.
Legal validity
Specific treatment must be refused	The document must say which treatment is refused, not just express a general wish.	true	Name treatments such as CPR, ventilation, dialysis, antibiotics or artificial nutrition and hydration.
Applicability
Circumstances must be clearly identified	A refusal only applies if the current circumstances match those described in the Advance Decision.	true	Describe diagnoses, stages of illness, symptoms or loss of abilities that trigger the refusal.
Legal validity
Life-sustaining refusal must be in writing	A refusal of life-sustaining treatment is not valid unless recorded in writing.	true	Use a written document rather than relying on spoken instructions.
Life-sustaining refusal must be signed	The maker must sign, or direct another person to sign in their presence.	true	Sign and date the final version clearly.
Witnessing
Signature must be witnessed for life-sustaining refusal	The witness confirms the signature or directed signature was made properly.	true	Ask an independent adult witness to sign and add their name, address and date.
Legal validity
Must say it applies even if life is at risk	A life-sustaining treatment refusal needs an express statement that it applies even if life is at risk.	true	Include wording such as: I refuse this treatment even if my life is at risk.
Applicability
Maker must lack capacity when treatment decision arises	An Advance Decision is used only when the person cannot make or communicate the treatment decision at the time.	true	If you have capacity, tell clinicians your current decision directly.
Current treatment must match the refused treatment	Clinicians must be able to see that the treatment now proposed is covered by the refusal.	true	Use both common and clinical names for key treatments where possible.
Current circumstances must match the document	A valid refusal may still not apply if the situation is materially different from the one described.	true	Avoid vague triggers and define the medical situations you mean.
Legal validity
It must not have been withdrawn	An Advance Decision is invalid if the maker withdrew it while they had capacity.	true	If revoking it, destroy old copies and tell your GP, attorneys and family.
No later conflicting health and welfare LPA	A later LPA may override an Advance Decision if it gives the attorney authority over the same treatment.	true	Check any health and welfare LPA is consistent with the Advance Decision.
No later conduct clearly inconsistent with it	The document may be invalid if the maker later acted in a way clearly inconsistent with the refusal.	true	Review the document after major life, health or belief changes.
Applicability
No reasonable grounds that circumstances were unanticipated	A refusal may not apply if later developments make it reasonable to think the maker would have reconsidered.	true	Update it when new treatments, diagnoses or prognosis information arise.
Legal validity
It cannot demand treatment	An Advance Decision refuses specified treatment it does not require clinicians to provide requested treatment.	false	Put treatment preferences in a separate advance statement or care plan.
It cannot request assisted dying	It can refuse treatment but cannot require anyone to take steps to end life.	true	Focus wording on refusals of specified medical treatment.
Communication
Oral refusals are limited	A spoken Advance Decision may be valid for non-life-sustaining treatment, but not for life-sustaining treatment.	true	Record all refusals in writing to avoid uncertainty.
Clinicians must be able to find it	A valid document may not be applied in an emergency if healthcare staff do not know it exists.	true	Give copies to your GP, hospital team, care home and emergency contacts.
Emergency contacts should be listed	Contacts can help clinicians locate the document and understand its background.	true	List trusted contacts, attorneys, GP details and where the original is stored.
Family and carers should know about it	People close to the maker may be asked about wishes and whether the document is current.	true	Discuss the decision with key relatives, carers and any appointed attorney.
Legal validity
Date should be clearly recorded	The date helps show whether the document came before or after an LPA or later changes.	true	Date every signature, witness signature, review and replacement copy.
Applicability
Reasons and values should be included	Reasons help clinicians decide whether the refusal applies to the situation now faced.	true	Briefly explain the outcomes or burdens you are trying to avoid.
Legal validity
Wording must not be ambiguous	Ambiguous wording makes it harder to decide whether the refusal is valid and applicable.	true	Avoid phrases such as no heroic measures unless you define them precisely.
Applicability
CPR refusal should be clearly linked to the Advance Decision	CPR is life-sustaining treatment, so a refusal needs the life-risk statement and proper formalities.	true	Discuss CPR refusal with your clinician and ask how it should be recorded locally.
Artificial nutrition and hydration should be named if refused	Clinically assisted nutrition and hydration may be treated as medical treatment and should be specified if refused.	true	State whether tube feeding, IV fluids or clinically assisted hydration are refused.
Antibiotics or infection treatment should be specified if refused	Infections are common triggers for treatment decisions in advanced illness.	true	Say whether antibiotics are refused in all cases or only in defined end-stage situations.
Ventilation refusal should distinguish invasive and non-invasive support	Breathing support can range from masks to intubation, so precise wording reduces disputes.	true	State whether you refuse intubation, mechanical ventilation, NIV, CPAP or all respiratory support.
Dialysis refusal should define the condition covered	Dialysis may be temporary or long term, so circumstances matter.	true	Say whether refusal applies to acute kidney injury, chronic kidney failure or both.
Blood product refusal should be precise	Different blood components may be acceptable or refused for different reasons.	true	List whether whole blood, red cells, plasma, platelets or derivatives are refused.
Implanted device treatment should be addressed if relevant	Devices such as ICDs may affect end-of-life treatment decisions.	true	Discuss ICD deactivation or device settings with your cardiology team.
Pain relief should not be accidentally refused	Refusing life-sustaining treatment does not normally mean refusing comfort care.	true	State that symptom relief, nursing care and comfort care are still wanted if that is your wish.
Pregnancy-related wishes should be addressed if relevant	Pregnancy may create circumstances the maker might want treated differently.	true	Say whether the refusal changes during pregnancy or childbirth.
Mental Health Act powers may affect treatment	The Mental Capacity Act does not override treatment powers under the Mental Health Act 1983.	false	Get specialist advice if the refusal concerns compulsory mental health treatment.
If not valid and applicable, best interests decision applies	If the Advance Decision cannot be relied on, treatment decisions are made under best interests rules.	true	Make the document clear and share it so clinicians do not need to rely on fallback rules.
Legal validity
Valid and applicable refusal has the same effect as a current refusal	Healthcare professionals must respect a valid and applicable Advance Decision as if the person had made it now.	true	Use direct refusal wording rather than preferences or hopes.
Applicability
Emergency treatment may be given while checking validity	Clinicians may treat to prevent serious deterioration while deciding whether an Advance Decision exists and applies.	true	Carry an alert card and ensure records flag the document.
Communication
Only the current version should circulate	Multiple versions can create doubt about the maker's current wishes.	true	Mark replacements as current, withdraw old copies and keep a distribution list.
Review
Regular review is strongly advisable	Review helps show the decision still reflects current wishes and circumstances.	true	Review at least every few years and after major medical or personal changes.
Review after diagnosis or prognosis changes	New medical information may affect whether the original refusal still applies.	true	Ask a clinician to review the wording after a serious diagnosis or change in prognosis.
Review when treatment options change	A new, less burdensome treatment could make old wording less certain.	true	Update the document if a new treatment would change your decision.
Review after making or changing an LPA	A later health and welfare LPA can affect the legal status of the Advance Decision.	true	Ensure the LPA and Advance Decision say who decides about the same treatments.
Review after major relationship changes	Relationship changes may affect contacts, attorneys and who knows your wishes.	false	Update contact details and send the new version to relevant people.
Witnessing
Witness should be independent where possible	Independence helps avoid later allegations of pressure or uncertainty.	true	Use an adult witness who is not a beneficiary, attorney or close family member if possible.
Witness should be present when the maker signs	For life-sustaining treatment refusals, the witness must witness the signature or directed signature.	true	Sign in the witness's presence and have them sign immediately afterwards.
Legal validity
Another person may sign if directed	If the maker cannot physically sign, someone else may sign for them in their presence and by their direction.	true	Record who signed, why, and that they signed by the maker's direction and in the maker's presence.
Capacity
Communication support should be used where needed	A person is not unable to decide merely because they communicate differently.	false	Use interpreters, communication aids or supported decision-making and note the support used.
Capacity should be presumed unless shown otherwise	Adults are presumed to have capacity unless there is evidence they lack it.	false	Do not assume incapacity because of age, disability, illness or an unwise decision.
An unwise refusal does not prove lack of capacity	A person can make a decision others think unwise and still have capacity.	true	Record that risks and consequences were understood when the decision was made.
Decision should be free from pressure	Coercion or undue influence may cast doubt on whether the refusal truly reflects the maker's decision.	true	Discuss serious refusals privately with a clinician or adviser and record that the decision was voluntary.
Review
Complex refusals should be discussed with a clinician	Clinical input helps make treatment names, consequences and circumstances accurate.	true	Ask your GP, consultant or palliative care team to review the wording.
Communication
Care providers should hold a copy	Care homes and hospitals often need quick access during deterioration or transfer.	true	Ask the care home and hospital team to add it to care records and handover notes.
Emergency services should be alerted if relevant	Emergency clinicians may need immediate evidence before withholding life-sustaining treatment.	true	Ask your GP or care team about local emergency care records, DNACPR forms or alert systems.
Advance statements are not the same as refusals	An advance statement expresses wishes and preferences an Advance Decision refuses specified treatment.	false	Keep refusal clauses separate from wider care preferences.
Legal validity
England and Wales law should be identified	The Mental Capacity Act 2005 rules apply in England and Wales other UK nations have different frameworks.	false	State the document is intended for use in England and Wales and seek local advice if moving within the UK.
Scotland uses different legal terminology	Scottish incapacity law differs from the Mental Capacity Act 2005 framework.	false	Take Scottish legal or clinical advice if the document may be used in Scotland.
Northern Ireland has a different capacity framework	Rules and terminology for future healthcare decisions may differ in Northern Ireland.	false	Get Northern Ireland-specific advice if treatment may occur there.
Communication
Document should be legible and accessible	Illegible or inaccessible documents are harder to rely on in urgent care.	true	Keep a clean signed copy, digital scan and clear note of where the original is held.
Legal validity
Document should not contain conflicting instructions	Contradictions can make it unclear whether the refusal applies.	true	Check that refusals, exceptions, advance statements and LPA wording align.
Communication
Information sharing consent may help	Clear permission can make it easier for clinicians to discuss the document with named contacts.	false	Name who may be contacted about the document and add their phone numbers.
Maker must be clearly identified	Clinicians must be sure the document belongs to the patient being treated.	true	Include full name, date of birth, NHS number if known, address and previous names.
Applicability
Exceptions should be tightly drafted	Unclear exceptions can make it difficult to decide whether treatment is refused.	true	State exactly when a refused treatment may still be given, if any exception is intended.
Communication
Palliative care wishes should be separated from refusals	Comfort care preferences guide care but are not usually treatment refusals.	false	Use a separate section for pain relief, place of care, spiritual needs and family contact.
Review
Reviews should be documented	A dated review note helps show the maker still intended the refusal to stand.	true	Add a signed and dated review statement, or execute a fresh version after major changes.

How Do You Make An Advance Decision Valid In England And Wales?

An Advance Decision must be made by a person aged 18 or over who has capacity at the time, and it must clearly identify the treatment being refused and the circumstances in which the refusal applies. For refusals of life-sustaining treatment, extra formalities apply: it must be in writing, signed by the maker or someone signing on their behalf, witnessed, and include a clear statement that the refusal applies even if life is at risk.

When Will Doctors Follow An Advance Decision?

Doctors must consider whether the Advance Decision is both valid and applicable to the current treatment and circumstances. It may not be followed if the person has withdrawn it, later made a conflicting Lasting Power of Attorney for health and welfare, acted inconsistently with it, or the current situation was not anticipated when it was made.

What Practical Steps Reduce The Risk Of Disputes?

Use precise wording for the treatment refused and the medical situations covered.
Add the statutory life-sustaining treatment wording if relevant.
Sign and witness the document correctly.
Tell your GP, hospital team, attorney and close family where the document is kept.
Review it after any major diagnosis, change in treatment options, or change in personal wishes.

Advance Decision Validity and Applicability Checklist

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FAQs

What is an Advance Decision validity and applicability checklist?

It helps you review whether an Advance Decision is likely to meet the legal requirements for refusing medical treatment in the UK, including validity and applicability at the time treatment is considered.

What is an Advance Decision in the UK?

What makes an Advance Decision valid?

What does applicability mean for an Advance Decision?

Does an Advance Decision refusing life-sustaining treatment need special wording?

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