ADRT Wales — How to Write an Advance Decision to Refuse Treatment

What the All Wales ADRT Form Covers

The All Wales ADRT form is the standard template issued by NHS Wales for documenting treatment refusals. It's available as a free download from the NHS Wales Performance and Improvement website under the Future Care Planning section. You can use this form or draft your own — the law doesn't require a specific format, only that the content meets the Mental Capacity Act 2005 requirements.

The All Wales form walks you through:

• Section 1: Your personal details, GP surgery, and NHS number
• Section 2: The specific treatments you refuse and the medical circumstances under which those refusals apply
• Section 3: The mandatory life-sustaining treatment declaration ("even if my life is at risk or may be shortened as a result")
• Section 4: Signature, date, and witness details
• Review section: A log for signing and dating periodic reviews to demonstrate the ADRT reflects your current wishes

The form is designed for clinical integration — once scanned by your GP surgery, it feeds into the Welsh Care Records Service and appears on the Welsh Clinical Portal under the "Future Care Plan discussed" tab.

Writing Refusals That Clinicians Will Follow

The single most common reason an ADRT fails in practice is vague language. An emergency department consultant at 3 a.m. cannot interpret "no heroic measures" or "no treatment if my quality of life is poor." Those phrases have no clinical definition, and under time pressure, the doctor's legal obligation is to act in your best interests — which usually means starting treatment.

Effective refusals name the treatment and the trigger:

• "I refuse cardiopulmonary resuscitation if I have been diagnosed with an advanced, irreversible neurological condition"
• "I refuse invasive mechanical ventilation if I am in a persistent vegetative state or minimally conscious state"
• "I refuse clinically assisted nutrition and hydration if I have end-stage dementia and can no longer swallow independently"

Each refusal should be a standalone clause. Clinicians assess each one individually against your current clinical situation — if a refusal applies, they must follow it; if it doesn't clearly apply, they treat.

Witnessing Rules for Life-Sustaining Treatment Refusals

If your ADRT includes any refusal of life-sustaining treatment (CPR, ventilation, artificial feeding, dialysis), the document must be:

1. In writing — handwritten or typed, not verbal
2. Signed by you (or signed by someone else in your presence and at your direction if you physically cannot sign)
3. Dated
4. Witnessed — the witness must be over 18 and must not be your spouse, civil partner, partner, or relative

The witness doesn't need to be a solicitor or medical professional. A neighbour, colleague, or friend is fine, provided they meet the independence criteria. Their role is to confirm that you signed voluntarily and appeared to have capacity — they're not certifying the document's legal validity.

If your ADRT only refuses treatments that are not life-sustaining (for example, refusing blood transfusions for religious reasons in non-emergency situations), the formal witnessing requirements don't apply. However, having a witness always strengthens the document's credibility if it's ever challenged.

Registering Your ADRT With the Welsh Clinical Portal

Drafting and signing the ADRT is half the job. The other half is making sure it's findable when it matters.

Step 1: Deliver the original to your GP surgery. Book a brief appointment or hand it to the practice manager. Ask them to scan the document to the Welsh Care Records Service (WCRS), which links to the Welsh Clinical Portal (WCP).

Step 2: Confirm the flag is active. After the scan, the WCP should display a "Future Care Plan discussed" indicator at the top of your patient record. This is visible to emergency department staff, ambulance clinicians, and out-of-hours services across NHS Wales. Ask your GP surgery to confirm the flag is showing.

Step 3: Set up the Green Bottle. Place a printed copy of your ADRT, along with your medication list and any DNACPR form, inside a plastic container in your fridge. Affix a green sticker to the inside of your front door. Welsh Ambulance Service paramedics are trained to check for this sticker and go straight to the fridge.

Step 4: Distribute copies. Send PDF copies to your LPA attorneys (if you have an LPA), your closest family members, and anyone likely to be with you during a medical crisis. More copies in more hands means more chances the document surfaces when it counts.

When to Review and Update

The All Wales ADRT form includes a dedicated review section — a simple log where you sign and date each time you confirm the document still reflects your wishes. There's no legal requirement to review on a fixed schedule, but the NHS Wales guidance recommends every two years or after any significant change in your health.

A recent review signature strengthens the ADRT's credibility enormously. If a clinician sees an ADRT signed eight years ago with no evidence of review, they may question whether it reflects the patient's current wishes — particularly if the patient's medical circumstances have changed significantly since it was written.

If you need to change a refusal, execute a new ADRT entirely. Don't amend the old one with handwritten additions — a fresh document with a new signature and witness eliminates any ambiguity about which version is current.

Our Wales ADRT planning guide includes the complete drafting workflow, pre-written refusal clauses for seven treatment categories, a witness checklist, and a GP registration script you can hand to your practice manager.

Get the full planning kit and make your treatment decisions legally binding before the window of capacity closes.

See more Wales guides →