Who Can Witness an ADRT UK

When Witnessing Is Required

Not every ADRT needs a witness. Under the Mental Capacity Act 2005, witnessing is only mandatory when your advance decision covers life-sustaining treatment — mechanical ventilation, clinically assisted nutrition and hydration, cardiopulmonary resuscitation, or any other intervention that, if withheld, could result in death.

For an ADRT that only refuses non-life-sustaining treatments, there is no statutory witnessing requirement. You can write it, sign it, and it is valid. However, having a witness strengthens the document against future challenges, and many practitioners recommend witnessing as standard practice regardless.

Who Qualifies as a Witness

For a life-sustaining refusal, the Mental Capacity Act 2005 requires the witness to be present when you sign the document and to sign it as well. Unlike an LPA, the Act does not set out an LPA-style disqualification list for ADRT witnesses. A family member, friend, or colleague can serve as a witness.

That said, practical advice from solicitors and charities like Compassion in Dying consistently recommends choosing a witness who has no financial interest in your death — not a beneficiary of your will, not someone who would inherit under intestacy rules. If the ADRT is ever challenged on grounds of undue influence or coercion, an independent witness makes the document significantly harder to contest.

The "Life at Risk" Statement

For refusals of life-sustaining treatment, your ADRT must include a written statement confirming that the decision applies "even if my life is at risk as a result." This exact phrase — or substantially similar wording — is a statutory requirement. Without it, a refusal of life-sustaining treatment is not legally binding.

The complete execution requirements for life-sustaining refusals:

1. The refusal must be in writing
2. You must sign it (or someone must sign at your direction, in your presence)
3. Your signature must be witnessed by a person who is present when you sign
4. The witness must also sign the document
5. The document must include the "even if my life is at risk as a result" statement

Missing any of these elements — particularly the witness signature or the life-at-risk clause — gives clinicians grounds to treat the document as unenforceable for that specific refusal.

Common Mistakes

The most frequent execution errors include:

Dating inconsistencies. The witness signs on a different date from the maker. While not automatically invalidating, this creates doubt about whether the witness was actually present during signing.

No witness for life-sustaining refusals. People assume that because the non-life-sustaining parts of the ADRT do not need witnessing, the whole document is fine without a witness. The life-sustaining refusals require the document to be signed and witnessed.

Using the certificate provider from your LPA as your ADRT witness. This is legally permissible but can create confusion. If both documents are later examined together, keeping the witness pools separate simplifies any validity review.

The England ADRT Guide includes a step-by-step execution protocol for each type of treatment refusal, with specific guidance on witness selection and document formatting to ensure first-time validity.

See more England guides →