Advance Directive for Young Adults and Parents in Wales — When to Start Planning

You Don't Need a Diagnosis to Make an ADRT

The Mental Capacity Act 2005 sets one eligibility criterion for creating an Advance Decision to Refuse Treatment: you must be 18 or over and have mental capacity. There's no minimum age beyond that, no requirement for a medical condition, and no clinical trigger needed.

Most people assume advance directives are for elderly or terminally ill patients. The data suggests otherwise. Road traffic accidents, strokes, sudden cardiac arrests, and traumatic brain injuries don't check your age before taking your capacity. A 25-year-old involved in a serious car crash on the M4 faces the same clinical decisions as an 85-year-old with end-stage dementia — CPR, ventilation, artificial feeding — with the same legal framework governing who decides.

Without an ADRT, the clinical team follows the best-interests framework: they consult your family, consider what they know about your values, and make the call themselves. Your parents or partner can share what they think you'd want, but they have no legal authority to refuse treatment on your behalf unless they hold a registered Health and Welfare LPA.

Why Young Adults Should Consider One

Three scenarios make ADRTs particularly relevant for people in their 20s and 30s:

Extreme sports and high-risk activities. Climbing, mountain biking, surfing, motorsport — if you regularly engage in activities where a serious injury could leave you incapacitated, an ADRT ensures your treatment preferences are documented before an accident happens. The Green Bottle scheme and Welsh Clinical Portal registration help make your wishes findable to paramedics and other clinicians.

Strong views on specific interventions. Some people have deeply held views about CPR, ventilation, blood transfusions, or organ donation that their families may not fully understand or agree with. An ADRT makes those views legally binding rather than relying on family consensus during a crisis.

Becoming a parent. If you have young children who depend on you, the planning question isn't just about your own treatment preferences — it's about ensuring that if something happens to you, someone has legal authority over your healthcare (via an LPA) and your children aren't left in administrative limbo while the Court of Protection processes a deputyship application.

When Parents Should Create an ADRT for Themselves

The trigger for most parents isn't their own health — it's realising that nobody has documented authority to make decisions for them if they're hit by a bus on the way to school pickup. Without an LPA and ADRT:

• Your partner cannot legally refuse treatment on your behalf
• Your partner cannot access your bank accounts or sell property
• If both parents are incapacitated simultaneously (a car accident with both in the vehicle), there's nobody with legal authority — the Court of Protection must appoint deputies, a process that takes months and costs thousands

Creating an ADRT and registering an LPA takes a few hours of paperwork and £92 per LPA form (£46 if your gross income is under £12,000). The alternative — deputyship through the Court of Protection — costs upwards of £5,000 and requires a court process.

Helping an Ageing Parent Create One

The other side of the coin: you're in your 40s or 50s, and your parent is in their 70s or 80s with no advance planning documents. This is the most common scenario for ADRT creation, and it comes with a distinct challenge — the conversation.

Starting the conversation isn't about preparing for death. It's about ensuring that if your parent loses capacity, their wishes drive the clinical decisions rather than a consultant's best guess. The framing that works: "If something happened and you couldn't speak for yourself, would you want the doctors to decide everything, or would you rather have it written down?"

The window of opportunity is narrower than most people realise. A dementia diagnosis doesn't automatically mean capacity is lost — early-stage diagnosis often leaves months or years where the person can still make legally valid decisions. But the window can close abruptly after a fall, an infection, or a single bad night. An ADRT signed before capacity declines is straightforward. An ADRT signed after capacity is borderline becomes a legal minefield that families and clinicians fight over.

If your parent is already showing signs of cognitive decline, the conversation needs to happen now — not next month, not after the next GP appointment, not when the family is all together at Christmas.

The Minimum Viable Plan

If full advance care planning feels overwhelming, start with two documents:

1. A Health and Welfare LPA — so someone you trust has legal authority to make healthcare decisions if you can't. £92 to register, 8–20 weeks processing. Do this first, because it requires registration with the OPG and has the longest lead time.

2. A basic ADRT — covering at minimum your position on CPR, ventilation, and artificial feeding. Deliver it to your GP surgery for Welsh Clinical Portal registration.

These two documents keep your family out of the Court of Protection and give clinicians clear direction. You can expand and refine them later — adding an Advance Statement, setting up the Green Bottle, distributing copies to family — but the ADRT's legal force starts when it is validly made, while the LPA must be registered with the OPG before it can be used.

Our Wales ADRT planning guide walks through the complete process from first conversation to GP registration, with templates, witness checklists, and LPA coordination guidance.

Get the complete planning kit and put your treatment decisions in writing while the window is wide open.

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