Advance Care Planning in Wales: ADRT, LPA, and My Life My Wishes

Advance care planning is not about giving up. It is about ensuring that if you cannot speak for yourself — because of an accident, a stroke, dementia, or a terminal diagnosis — the healthcare system treats you the way you would want. In Wales, this has a specific legal and clinical framework that differs from England in important ways, and getting it right now means your family is not left making impossible decisions at the worst possible moment.

This guide covers the three documents that form a complete advance care plan for Welsh residents: the NHS Wales My Life My Wishes document, an Advance Decision to Refuse Treatment (ADRT), and a Lasting Power of Attorney (LPA). You need all three — they do different things, and none is a substitute for the others.

The NHS Wales Framework: My Life My Wishes

NHS Wales uses a specific document called "My Life, My Wishes" (Fy Mywyd, Fy Nymuniadau in Welsh) as the standard advance care planning record across Welsh healthcare trusts. This is not the same as the advance directive templates used in England under NHS England frameworks.

My Life My Wishes is not legally binding in the way that an ADRT or LPA is, but it carries significant clinical weight. When a GP, district nurse, paramedic, or hospital clinician in Wales sees a completed My Life My Wishes document in your records, they are expected to take your preferences seriously and document any deviation from them.

The document covers:

• Your preferred place of care if your condition deteriorates (home, hospice, care home, or hospital)
• Your preferred place of death
• Specific cultural, linguistic, or religious preferences — including, in Wales, whether you want Welsh-language care and communication
• Wishes regarding resuscitation — though for a do not attempt cardiopulmonary resuscitation (DNACPR) decision to be clinically binding, it must be signed by a doctor
• People you want to be consulted and involved in decisions about your care
• Information you want shared (or not shared) with specific family members

You can complete My Life My Wishes yourself and ask your GP to add it to your medical record. Ask your GP surgery or community nurse team for a copy of the current Welsh version, or download it from the NHS Wales / health board website for your area.

If you speak Welsh and want Welsh-language care, documenting this explicitly in My Life My Wishes creates a record that the healthcare system is legally required to accommodate under the Welsh Language (Wales) Measure 2011.

Advance Decision to Refuse Treatment (ADRT)

An ADRT — sometimes called an advance directive or living will — is a legally binding document that allows you to refuse specific medical treatments in specific future circumstances, even if you later lose capacity to make decisions. It is governed by the Mental Capacity Act 2005, which applies across England and Wales.

An ADRT is only about refusal. You cannot use it to demand specific treatments (for example, you cannot require clinicians to keep you on a ventilator indefinitely). But you can refuse:

• Cardiopulmonary resuscitation (CPR)
• Mechanical ventilation
• Artificial nutrition and hydration (tube feeding)
• Specific medications like blood transfusions (relevant for Jehovah's Witnesses)
• Admission to hospital if you are in a care home

Validity requirements

For an ADRT to be legally binding, it must meet specific conditions:

For refusal of life-sustaining treatment specifically:

• It must be in writing
• You must sign it in the presence of a witness, who also signs
• It must include the statement: "I intend this decision to apply even if my life is at risk"
• You must have had mental capacity when you signed it

For any other treatment refusal:

• Writing is strongly recommended (verbal ADRTs are technically valid but practically unenforceable)
• The circumstances triggering the refusal must be clearly described
• It must have been made with capacity

There is no official government form for an ADRT in Wales or England. You can write your own, use a template from a reputable charity (Compassion in Dying and the British Medical Association both provide templates), or have a solicitor draft one. The important thing is that it is specific and unambiguous — vague ADRTs ("I don't want to be kept alive on machines") are too imprecise for clinical staff to rely on safely.

Storing and sharing your ADRT

An ADRT is useless if clinicians cannot find it. You should:

• Give a copy to your GP to keep in your medical records
• Give a copy to your LPA attorney (see below)
• Keep the original at home in an accessible location (not locked in a safe)
• Carry a card in your wallet noting that an ADRT exists and where it is held
• If you are admitted to hospital, take a copy with you

In Wales, if you also complete My Life My Wishes and link it to your ADRT (noting in My Life My Wishes that an ADRT exists), clinical staff dealing with an emergency have one coherent picture of your wishes.

Lasting Power of Attorney: Two Types, Both Necessary

An LPA is a legal document appointing someone (your attorney) to make decisions on your behalf if you lose mental capacity. There are two entirely separate LPAs:

LPA for Property and Financial Affairs: Your attorney can manage your bank accounts, pay bills, sell property, and deal with pension and investment accounts. This LPA can be used while you still have capacity (with your permission), making it practical for ordinary life management as well as end-of-life planning.

LPA for Health and Welfare: Your attorney can consent to or refuse medical treatment on your behalf, decide where you live, and make day-to-day welfare decisions. Critically, an LPA can specify whether your attorney has authority to refuse life-sustaining treatment — if this is not explicitly stated, the attorney does NOT have this power by default.

Why both matter

An ADRT covers specific situations you have anticipated. But life is unpredictable — situations arise that you did not think to address in your ADRT. Your health and welfare attorney can fill that gap, making decisions in your best interests based on knowing you and your values. An ADRT and an LPA work together, not in competition.

The current fee and fee remission

As of November 2025, the registration fee for each LPA in England and Wales is £92 per document — so £184 for both. The LPA must be registered with the Office of the Public Guardian (OPG) before it can be used.

If you earn under £12,000 per year, you can apply for a 50% reduction using Form LPA120. If you receive certain means-tested benefits (Universal Credit, Pension Credit, Income Support), the fee may be waived entirely. Do not pay £184 without checking the LPA120 remission criteria first.

How long does registration take?

The OPG typically takes 8 to 10 weeks to register an LPA once submitted. If you or a family member is facing a deteriorating health condition, begin the LPA process immediately. Once a person loses mental capacity, it is too late to make an LPA — the only route then is a Deputyship Order through the Court of Protection, which costs significantly more and takes months.

The Sequence: Do This in the Right Order

The optimal order for completing an advance care plan in Wales:

1. Complete My Life My Wishes and share with your GP — this can be done today, costs nothing, and immediately creates a healthcare record of your preferences
2. Create an LPA for Health and Welfare and for Property and Financial Affairs — register both with the OPG; this takes 8-10 weeks but is foundational
3. Draft an ADRT if you have specific treatment refusals in mind — do this after the LPA, as it can then be referenced within the LPA and shared with your attorney

Do not rely on family members being able to make healthcare decisions for you simply because of the relationship. Without a registered LPA, a spouse or adult child has no legal authority to direct your medical treatment. Clinicians will make decisions based on your best interests, but "best interests" may not align with your actual wishes if those wishes are undocumented.

Planning Ahead Protects Your Whole Family

The families who struggle most with Welsh bereavement administration are often those where no planning took place — where there is no will, no LPA, and no advance care plan. Estate administration without a will follows rigid intestacy rules that may not reflect what the deceased wanted. Healthcare decisions without an LPA become medical emergencies for clinicians and emotional crises for families.

If you are using the Wales Survivor Benefits Navigator to manage a bereavement that has already happened, the advance care planning chapter also serves as a guide to putting your own documents in order — so the next generation does not face the same administrative maze.

See more Wales guides →