Advance Directive Signing and Witness Rules in Wales

When Witnessing Is Legally Required

Not every ADRT needs a witness. The Mental Capacity Act 2005 draws a clear line: if your ADRT refuses life-sustaining treatment — any treatment a doctor considers necessary to keep you alive — then the document must be:

1. In writing
2. Signed by you (or by someone else at your direction if you physically cannot sign)
3. Dated
4. Witnessed by an independent adult

If your ADRT refuses only non-life-sustaining treatments (for example, refusing a specific type of physiotherapy or a non-emergency surgical procedure), the formal signing and witnessing requirements don't technically apply. The refusal can even be verbal, though that's almost impossible to enforce in practice.

In reality, most ADRTs that matter — the ones refusing CPR, ventilation, artificial feeding, or dialysis — refuse life-sustaining treatment. So for any ADRT worth creating, treat the full signing protocol as mandatory.

Who Can Witness Your ADRT

The witness must be:

• Over 18 years old
• Not your spouse, civil partner, or partner (whether married or not)
• Not a relative (parent, child, sibling, grandparent, aunt, uncle, niece, nephew)
• Physically present when you sign — they cannot witness remotely via video call

Beyond these restrictions, anyone qualifies. You do not need a solicitor, doctor, or notary. A neighbour, work colleague, friend, or community volunteer is perfectly acceptable.

The witness's role is limited but important: they confirm that they saw you sign the document and that you appeared to do so voluntarily. They are not certifying the document's legal validity or your mental capacity — those are separate matters.

The Exact Wording That Makes It Binding

For any refusal of life-sustaining treatment, your ADRT must include a specific written declaration. The standard formulation is:

"I have made this advance decision to apply even if my life is at risk or may be shortened as a result."

This statement can appear once at the top of the document (covering all subsequent treatment refusals) or be attached to each individual refusal clause. Either approach satisfies the Act, but including it with each clause removes any ambiguity about which refusals are intended to be life-sustaining.

Without this statement, an ADRT that refuses CPR or ventilation is not valid for those refusals — even if everything else is perfect. The clinician must then make a best-interests decision rather than being bound by that refusal.

Common Mistakes That Invalidate the Document

Wrong witness. A husband witnessing his wife's ADRT, or a daughter witnessing her mother's. The relationship exclusion is strict. Even if the witness is willing, cooperative, and clearly acting in the signer's best interests, the document fails the statutory test.

Undated document. The date matters because chronological order determines legal priority between an ADRT and an LPA. If an ADRT is undated, a clinician or court cannot determine whether it was made before or after a Health and Welfare LPA — and if the LPA came later with authority over life-sustaining treatment, it overrides the ADRT.

No life-sustaining declaration. The most frequent cause of ADRT failure. The signer lists specific treatment refusals — CPR, ventilation, CANH — but omits the mandatory statement about the refusal applying "even if life is at risk." Clinically, the ADRT looks comprehensive. Legally, it's incomplete.

Digital or photocopied signatures. The ADRT must carry original "wet ink" signatures. A document emailed and printed, then signed — that's fine. A document signed digitally via DocuSign or Adobe Sign — currently does not meet the Act's requirements.

Stale without review. Not technically invalidating, but practically dangerous. An ADRT signed 10 years ago with no evidence of review raises legitimate clinical questions about whether it still reflects the signer's wishes. The All Wales ADRT form includes a review section specifically for this — use it.

Signing Sequence When You Also Have an LPA

If you're creating both an ADRT and a Health and Welfare LPA, the order of signing has legal consequences:

• ADRT signed after the LPA: the ADRT overrides the attorney's authority for those specific treatments. The attorney cannot consent to treatments the ADRT refuses.
• LPA signed after the ADRT: the LPA overrides the ADRT if the attorney is granted authority over life-sustaining treatment — unless you explicitly reference the ADRT in Section 7 of the LPA form and attach a copy during registration.

The safest approach is to sign the LPA first, then the ADRT, and reference the LPA in the ADRT document. This makes the hierarchy unambiguous: the ADRT's specific refusals take precedence, while the LPA attorney handles everything the ADRT doesn't cover.

Our Wales ADRT planning guide includes a step-by-step signing checklist, witness eligibility verification, and a coordination protocol for aligning your ADRT with an LPA so neither document creates unintended gaps or conflicts.

Get the complete planning kit and avoid the execution mistakes that render advance directives unenforceable.

See more Wales guides →