Does an Advance Decision need to be witnessed?

A witness is required if the Advance Decision refuses life-sustaining treatment. The witness should see you sign the document and then sign it themselves.

Can an Advance Decision refuse life-sustaining treatment?

To refuse life-sustaining treatment, your Advance Decision must state that the refusal applies even if life is at risk. Without this wording, it may not be valid for that purpose.

What cannot be included in an Advance Decision?

No. An Advance Decision cannot request treatment, demand assisted dying, or refuse basic care such as warmth, shelter, hygiene, and food or drink by mouth.

When can an Advance Decision become invalid?

An Advance Decision is not valid if you later withdraw it, make a conflicting Lasting Power of Attorney for health and welfare, or do something clearly inconsistent with the decision.

Is an Advance Decision legally binding in the UK?

An Advance Decision is legally binding in England and Wales if it is valid and applicable to the circumstances. Different rules may apply in Scotland and Northern Ireland.

Can I change or cancel my Advance Decision?

You can revoke an Advance Decision at any time while you have capacity. Revocation can be written, verbal, or shown by conduct that is inconsistent with the decision.

Where should I keep my Advance Decision?

You should keep the signed document accessible and tell your GP, hospital, attorney, family, or carers where it is stored so it can be found when needed.

EN-GB>Wills>Advance Decision>United Kingdom Advance Decision Validity Rules

Advance Decision Validity Requirements In The United Kingdom

Created: 9 Jun 2026

Understanding validity requirements helps you create an advance decision that is clear, reliable and relevant under UK rules. This guide explains the key criteria and complements our AI Generated British Advance Decision resources.

Requirement	Explanation	Importance Level	Practical Check
Age
Maker must be 18 or over	An Advance Decision only has legal effect if made by an adult aged 18 or above.	Always important	Record the maker's date of birth and the date the Advance Decision was signed.
Capacity
Maker must have mental capacity when making it	The refusal must be made at a time when the person can understand, retain, use or weigh the relevant information and communicate the decision.	Always important	If capacity could be questioned, ask a doctor or solicitor to record a capacity assessment.
Capacity should not be doubted merely because of age, illness or disability	A person is presumed to have capacity unless it is established that they lack it.	May depend on circumstances	Do not reject the document only because the maker was elderly, disabled or seriously ill.
Maker should have had practicable support before capacity is treated as lacking	A person is not unable to decide unless all practicable steps to help them decide have failed.	May depend on circumstances	Note any help given, such as plain-language explanation, interpreter support or extra time.
An unwise refusal does not prove lack of capacity	The fact that a refusal seems risky or unusual does not by itself mean the person lacked capacity.	May depend on circumstances	Focus on the decision-making process, not whether others agree with the choice.
Refusal must operate only if the person later lacks capacity	An Advance Decision is a future refusal that applies when the person lacks capacity to consent to or refuse treatment at the relevant time.	Always important	Use current consent or refusal if the person still has capacity when treatment is proposed.
Specific treatment refusal
Treatment refusal must be specific	The document must specify the treatment that is to be refused, rather than making a general request for no care.	Always important	Name treatments such as CPR, ventilation, artificial nutrition or antibiotics where relevant.
Circumstances must be identified where relevant	A refusal may specify circumstances, and it will not apply if those circumstances are absent.	Always important	State the clinical situations clearly, such as permanent unconsciousness or advanced dementia.
Refusal does not apply if specified circumstances are absent	If the document limits the refusal to certain circumstances, clinicians need not follow it outside those circumstances.	Always important	Avoid vague triggers match each treatment refusal to clear situations.
It can refuse treatment but cannot demand treatment	An Advance Decision is legally about refusing specified treatment, not requiring doctors to provide a particular treatment.	May depend on circumstances	Put treatment preferences in an advance statement, not as binding refusals.
Written form
Non-life-sustaining refusals may be oral or written	The Act does not require every Advance Decision to be written, but written evidence is much safer in practice.	May depend on circumstances	Write it down even if the refusal is not about life-sustaining treatment.
Life-sustaining treatment refusal must be in writing	A refusal of life-sustaining treatment is not valid unless it is recorded in writing.	Especially important for life-sustaining treatment	Use a written document for any refusal involving CPR, ventilation or other life-sustaining treatment.
Signature and witnessing
Life-sustaining treatment refusal must be signed	The maker must sign the written refusal, or another person may sign it on their behalf in their presence and at their direction.	Especially important for life-sustaining treatment	Check the signature appears and, if signed by someone else, record why and at whose direction.
Signature must be witnessed for life-sustaining treatment refusal	The signature, whether by the maker or another person, must be made or acknowledged in the presence of a witness who signs the document.	Especially important for life-sustaining treatment	Include witness name, signature, date and contact details on the same document.
Life-sustaining treatment statement
Must state it applies even if life is at risk	A refusal of life-sustaining treatment must include a clear statement that it is to apply even if life is at risk.	Especially important for life-sustaining treatment	Use the statutory wording or very close wording: applies even if my life is at risk.
Specific treatment refusal
Refusal must match the proposed treatment	An Advance Decision is not applicable if the treatment being considered is not the treatment specified in the refusal.	Always important	Review whether medical names and lay descriptions cover the treatment actually being offered.
Capacity
It applies only when the person now lacks capacity for that treatment decision	If the person currently has capacity to decide about the treatment, their current decision controls.	Always important	Assess capacity at the time treatment is proposed, not only when the document was made.
No later contradictory action
It must not have been withdrawn	An Advance Decision is invalid if the maker withdrew it while they had capacity to do so.	Always important	Ask whether the maker later revoked it verbally, in writing or by destroying the document.
Withdrawal need not follow a formal written process	The Mental Capacity Act allows withdrawal or alteration of an Advance Decision at any time while the person has capacity.	May depend on circumstances	Record any later verbal change and notify people holding copies.
No later health and welfare LPA must override it	An Advance Decision is invalid if the maker later gives an attorney authority to make the same treatment decision.	Always important	Check the date and scope of any registered health and welfare LPA.
No later inconsistent conduct giving reasonable grounds to think wishes changed	The refusal is invalid if the person later did anything clearly inconsistent with it, giving reasonable grounds to believe they changed their mind.	Always important	Look for later statements, religious changes, treatment choices or updated care plans.
No unforeseen circumstances that would have affected the decision	An Advance Decision is not applicable if there are reasonable grounds to believe circumstances exist that the person did not anticipate and that would have affected the refusal.	May depend on circumstances	Review it after diagnosis, pregnancy, new treatments or major changes in prognosis.
Pregnancy may affect applicability if not anticipated	Pregnancy does not automatically cancel an Advance Decision, but may be a circumstance the maker should address expressly.	May depend on circumstances	State whether the refusal should apply during pregnancy and discuss it with a clinician.
Specific treatment refusal
It cannot refuse basic care needed to keep the person comfortable	An Advance Decision cannot refuse basic nursing care such as warmth, shelter, hygiene and comfort measures.	May depend on circumstances	Limit refusals to medical treatments, not comfort care or basic nursing support.
It cannot request anything unlawful such as assisted dying	The document can refuse treatment but cannot require anyone to help end life or provide unlawful treatment.	May depend on circumstances	Remove wording that asks clinicians to cause death or provide unlawful assistance.
Life-sustaining treatment statement
Artificial nutrition and hydration refusals may need life-sustaining treatment formalities	Clinically assisted nutrition or hydration can be life-sustaining, so refusals should meet the stricter written, signed, witnessed and risk-to-life requirements.	Especially important for life-sustaining treatment	Treat CANH refusals as life-sustaining and include the required statutory statement.
CPR refusal should meet life-sustaining treatment formalities	Cardiopulmonary resuscitation is normally life-sustaining treatment, so a future refusal should satisfy the stricter formalities.	Especially important for life-sustaining treatment	Use clear wording such as I refuse CPR in the stated circumstances, even if my life is at risk.
Ventilation refusal should meet life-sustaining treatment formalities	Mechanical ventilation may keep a person alive, so a future refusal should be written, signed, witnessed and include the risk-to-life statement.	Especially important for life-sustaining treatment	Specify invasive and non-invasive ventilation if both are refused.
Specific treatment refusal
Antibiotic refusal may need careful circumstances wording	Antibiotics may be minor or life-sustaining depending on the illness, so the refusal should state when it applies.	May depend on circumstances	Say whether antibiotics are refused only for life-threatening infection or more broadly.
Each refused treatment should be separately stated	Separate treatment refusals reduce uncertainty about what is covered and when it applies.	Always important	Use a separate bullet or clause for each treatment and set of circumstances.
Written form
Maker should be clearly identified	Clear personal details help clinicians confirm the document belongs to the patient.	May depend on circumstances	Include full name, date of birth, address and NHS number if known.
Document should be dated	A date helps prove age, capacity timing, and whether any later LPA or conduct came after the refusal.	Always important	Date the document and any later review, confirmation or amendment.
No later contradictory action
Regular review helps show continuing wishes	Review is not a statutory formality, but it reduces doubt about later changes in wishes or circumstances.	May depend on circumstances	Review after major diagnosis, treatment change, relationship change or every few years.
Written form
Relevant people should know where it is kept	A valid Advance Decision may not be followed if clinicians cannot find it when treatment is needed.	May depend on circumstances	Give copies to the GP, hospital, care home, family, attorney and emergency contacts.
Specific treatment refusal
Valid and applicable refusal has the same effect as a contemporaneous capacitous refusal	If valid and applicable, the refusal must be respected as though the person currently had capacity and refused the treatment.	Always important	If it meets the requirements and applies, clinicians should not provide the refused treatment.
No later contradictory action
Clinicians may treat if validity or applicability is reasonably doubted	A person does not incur liability for treatment if they reasonably believe no valid and applicable Advance Decision exists.	May depend on circumstances	Remove avoidable uncertainty by using clear wording, dates, signatures and accessible copies.
Emergency treatment may continue while validity is checked	Life-sustaining or deterioration-preventing treatment is permitted while a decision is sought from the court or validity is clarified.	May depend on circumstances	Make the document easy to locate quickly in emergencies.
Serious disputes may need Court of Protection clarification	The Court of Protection can determine whether an Advance Decision exists, is valid, or is applicable.	May depend on circumstances	Seek urgent legal or clinical governance advice if family or clinicians dispute the refusal.
Specific treatment refusal
It must be a refusal, not merely a preference statement	Preferences about care are relevant but are not the same as a legally binding refusal of specified treatment.	Always important	Use decisive refusal wording such as I refuse, not only I would prefer not to have.
Blanket wording such as no treatment may be too vague	General wording may fail to specify the treatment or circumstances closely enough to be applied safely.	Always important	Replace broad wording with named treatments and stated clinical circumstances.
No later contradictory action
DNACPR records should be consistent with the Advance Decision	A DNACPR form is different from an Advance Decision, but inconsistency can create doubt about CPR wishes.	May depend on circumstances	Ask the GP or care team to ensure CPR records reflect the Advance Decision.
Old copies should be replaced after amendments	Different versions can make clinicians unsure which refusal reflects the maker's current wishes.	May depend on circumstances	Destroy superseded versions and tell copy holders which version is current.
Capacity
Clinical discussion can support informed refusal	Discussing the refusal with a healthcare professional helps evidence understanding of treatment consequences.	May depend on circumstances	Ask the clinician to note the discussion and capacity in medical records.
Signature and witnessing
Witness should be independent and able to confirm the signature	The Act requires witnessing for life-sustaining treatment refusals using an independent adult witness reduces later disputes.	Especially important for life-sustaining treatment	Use an adult witness who is not pressuring the maker and can be contacted later.
Capacity
Decision should be voluntary and free from pressure	Coercion or undue pressure may create serious doubt about whether the refusal truly represents the maker's decision.	May depend on circumstances	Meet privately with the maker if there is any concern about pressure by relatives or carers.
No later contradictory action
New treatment options may affect applicability	If a new treatment or improved prognosis was not anticipated and might have affected the refusal, applicability may be doubted.	May depend on circumstances	Review the Advance Decision after major medical advances or changes in diagnosis.
Written form
Statutory Advance Decision rules apply in England and Wales	The Mental Capacity Act 2005 rules on Advance Decisions apply to England and Wales Scotland and Northern Ireland have different legal frameworks.	Always important	For use outside England and Wales, get local legal advice before relying on the document.

What Makes An Advance Decision Valid In England And Wales?

An Advance Decision is most reliable when it is made by a person aged 18 or over who has mental capacity, clearly identifies the treatment being refused, and is made before the treatment decision is needed. If it refuses life-sustaining treatment, it must be in writing, signed by or on behalf of the person, witnessed, and include an express statement that it applies even if life is at risk.

When Can An Advance Decision Be Ignored?

Healthcare professionals may lawfully treat despite an Advance Decision if there are reasonable grounds to believe it is invalid or not applicable. Key risk factors include later inconsistent behaviour, a later Lasting Power of Attorney giving treatment decision powers, unclear wording, major changes in circumstances, or uncertainty about capacity at the time it was made.

How Should You Check An Advance Decision Before Relying On It?

Check age and capacity: the maker must have been 18 or over and had capacity when the refusal was made.
Check the treatment: the refusal must specify the treatment clearly enough for clinicians to apply it.
Check life-sustaining treatment wording: a refusal of life-sustaining treatment needs the statutory written, signed, witnessed and risk-to-life statement requirements.
Check for later changes: later written or verbal withdrawals, inconsistent conduct, or a later health and welfare LPA may affect validity.
Tell the right people: give copies to the GP, hospital teams, family or attorneys so the document can be found when needed.

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FAQs

What are the validity requirements for an Advance Decision in the UK?

An Advance Decision is valid in England and Wales if you are 18 or over, have mental capacity when making it, clearly specify the treatments you refuse, and state the circumstances in which the refusal applies.

Does an Advance Decision need to be in writing?

How old do I need to be to make an Advance Decision?

Do I need mental capacity to make an Advance Decision?

What treatments can I refuse in an Advance Decision?

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