Advance Decision Age Requirement England

The Short Answer

You must be 18 or older to make an Advance Decision to Refuse Treatment in England. That threshold comes directly from Section 24(1) of the Mental Capacity Act 2005, which defines an advance decision as a decision made by "a person who has reached 18." There is no upper age limit and no requirement that you be ill, elderly, or facing a specific diagnosis.

The same Act sets a second requirement alongside age: you must have the mental capacity to understand the treatment decisions you are documenting at the time you make the ADRT. Age alone is necessary but not sufficient.

Why the Threshold Is 18 and Not 16

English medical law already allows 16- and 17-year-olds to consent to treatment under the Family Law Reform Act 1969. And under Gillick competence principles, children under 16 can consent to treatment if they demonstrate sufficient understanding. But the Mental Capacity Act 2005 drew a deliberate line: the power to refuse treatment in advance, particularly life-sustaining treatment, belongs only to legal adults.

The reasoning is protective. An ADRT refusing life-sustaining treatment is legally binding on clinicians. Once it takes effect, the consequences are irreversible. Parliament decided that power requires full legal adulthood, not the sliding-scale maturity assessment used for contemporaneous consent.

This means a 17-year-old facing surgery is presumed to have capacity to decide about it, but a refusal that may lead to death or severe permanent injury can be overridden by the Court of Protection; they cannot create a binding document refusing it in advance if they later lose capacity.

What "Capacity" Means Alongside Age

Meeting the age requirement is only the first gate. Under Sections 2 and 3 of the Mental Capacity Act, the person making the ADRT must pass a two-stage capacity test at the time they create the document:

Stage 1 asks whether there is an impairment of, or disturbance in the functioning of, the mind or brain. This could be a diagnosed condition like dementia, a brain injury, or a severe mental health episode.

Stage 2 asks whether that impairment prevents the person from understanding the information relevant to the decision, retaining it long enough to weigh it, using it to reach a decision, or communicating that decision.

If Stage 1 finds no impairment, or Stage 2 finds that the impairment does not prevent understanding, retaining, weighing, or communicating the decision, the person has capacity to make the ADRT. A diagnosis alone does not remove capacity. Someone in the early stages of Alzheimer's can create a perfectly valid ADRT, provided they understand the treatment refusals they are documenting and their consequences.

For anyone where capacity might later be questioned — a person with an early-stage cognitive diagnosis, for instance — having a GP or other medical professional witness the signing provides valuable evidence that capacity existed at the time the document was executed.

Young Adults and the Case for Early Planning

Most people associate advance care planning with old age. In practice, the adults who face the starkest consequences of not having an ADRT are often younger.

Consider a 25-year-old involved in a serious road accident who suffers a traumatic brain injury. Without a valid ADRT, the clinical team defaults to aggressive life-sustaining treatment under their "best interests" assessment. The patient's family has no automatic legal authority to refuse treatment on their behalf; they would need a Health and Welfare LPA registered with the Office of the Public Guardian before the accident or a relevant Court of Protection order — which, statistically, almost no one under 40 has done.

The Mental Capacity Act does not require a triggering diagnosis or a particular reason. An 18-year-old heading to university can create an ADRT just as validly as a 75-year-old with a terminal diagnosis.

How Age Interacts with an LPA

A Lasting Power of Attorney for Health and Welfare also requires the donor to be 18 or older. The two documents serve different but complementary purposes: the ADRT specifies binding treatment refusals, while the LPA appoints someone to make broader welfare decisions on your behalf.

If you create both, the chronological order matters. An LPA made after an ADRT can override the ADRT's refusals once the LPA is registered, provided the LPA explicitly grants the attorney authority over life-sustaining treatment. Conversely, an ADRT made after the LPA takes precedence over the attorney's powers for the specific treatments it covers.

For younger adults especially, pairing both documents fills the gap that age alone cannot: it ensures someone you trust has legal standing to advocate for you, while your specific refusals are binding when the ADRT is valid and applicable.

The full signing sequence, witness rules, and the "life at risk" clause requirements for life-sustaining treatment refusals are covered in our England ADRT guide.

What to Do Next

If you are 18 or older and want to create an ADRT, you need to document your treatment refusals with clinical precision — vague language gives clinicians grounds to argue the document does not apply to the specific situation they are treating. Our complete ADRT toolkit includes drafting worksheets with specific clinical phrasing templates, the correct signing protocol, and a GP consultation prep sheet to walk you through the process without solicitor fees.

See more England guides →