Advance Directive Signing and Witnessing Rules in Scotland

No Prescribed Form Does Not Mean No Rules

Scotland has no statutory advance directive form and no government registration process, which leads some people to assume there are no formalities at all. That is wrong. Common law sets clear expectations for how the document should be executed, and failing to meet them is the single most common reason advance directives get challenged or ignored in clinical settings.

Here is what Scottish common law and clinical practice actually require.

Who Can Sign

Any adult aged 16 or over who has decision-making capacity can create and sign an advance directive in Scotland. The AWI Act sets Scotland's age of capacity at 16 — two years younger than the 18-year threshold in England and Wales.

"Capacity" means you understand what you are refusing, why you are refusing it, and the medical consequences of that refusal. If you are creating the directive while dealing with a condition that could affect cognition (early-stage dementia, for example), having a doctor confirm your capacity at the time of signing adds significant legal weight.

Witnessing Requirements

There is no statute that mandates witnessing, but an unwitnessed advance directive is dramatically weaker in practice. Medical teams faced with an unwitnessed document and a family member challenging its validity will almost always err on the side of treatment.

Who qualifies as a witness:

• Any independent adult who is present when you sign
• A neighbour, colleague, or friend all work

Who does not qualify:

• Your spouse or civil partner
• A blood relative
• Anyone named as your welfare attorney
• Anyone who stands to benefit from the decisions in the document

Best practice: Use your GP or a solicitor as the witness. A medical professional who witnesses the signing can simultaneously attest that you had capacity — which is the strongest possible defence against future challenge. This is not legally required, but it significantly reduces the risk of the document being set aside.

The witness should sign, print their full name, and include their address and the date.

What to Include in the Document

A robust Scottish advance directive needs these components:

1. Your personal details — full legal name, date of birth, and address.

2. A capacity statement — "I am writing this document while I have full decision-making capacity and understand the nature and consequences of the decisions recorded here."

3. Specific treatment refusals — name the exact treatments you refuse and the exact clinical scenarios in which the refusals apply. Avoid vague language. "I refuse mechanical ventilation, cardiopulmonary resuscitation, and clinically assisted nutrition and hydration in the event of persistent vegetative state, advanced dementia with no prospect of regaining decision-making capacity, or end-stage terminal illness with no reasonable prospect of recovery" is clear. "No heroic measures" is not.

4. The sanctity-of-life clause — "I maintain these refusals even if my life is at risk." Without this explicit statement, clinicians in Scotland may legally override the directive to preserve life in ambiguous situations.

5. A welfare attorney reference (if applicable) — if you have a welfare POA, include the attorney's name and a clause directing them to enforce the advance directive. If you do not have a POA, note that here too, so clinicians know to proceed under the directive alone.

6. Signature and date — your handwritten signature, printed name, and the date.

7. Witness details — the witness's signature, printed name, address, and date.

Where to Store It

An advance directive stored in a filing cabinet at home is invisible to the NHS Scotland emergency system. The document needs to exist in multiple locations:

Essential:

• Your GP practice — deliver a copy and ask them to scan it into your electronic patient record. Request a clinical alert flag and ask for it to be uploaded to the NHS Key Information Summary (KIS) database. This is the record that paramedics, NHS 24, and hospital staff check first.
• Your welfare attorney — if you have one, they need a physical copy so they can present it in clinical settings.

Recommended:

• Your next of kin — even if they are not your attorney, having a copy means they can produce it in an emergency.
• Your hospital consultant — if you have a specialist you see regularly, lodge a copy with their department.
• A wallet card — a small card in your wallet noting that an advance directive exists, where the original is stored, and the registered OPG reference number for your welfare POA (if applicable).

The original: Keep the signed original in a secure but accessible location at home. Your attorney and next of kin should know where it is.

Review and Update Schedule

An advance directive does not expire, but a document written ten years ago may not reflect your current wishes. Review and re-sign at least:

• After any new medical diagnosis
• After any hospitalisation or significant health event
• When you change GP practice
• If you move to a different part of Scotland (update the GP copy)
• Every three to five years as a matter of course

Each time you re-sign, deliver a new copy to your GP and ask them to update the KIS entry.

For a complete signing checklist, witness declaration template, and the GP letter that gets your directive onto the KIS database, the Scotland Advance Directive Planning Kit includes everything you need to execute the document properly the first time.

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