LPA vs ADRT in Wales: Which Document Do You Need?

Two Documents, Two Different Jobs

A Health and Welfare Lasting Power of Attorney and an Advance Decision to Refuse Treatment both deal with medical decisions — but they work in fundamentally different ways, and understanding the distinction matters more than most families realise.

A Health and Welfare LPA appoints a person (your attorney) to make healthcare decisions on your behalf if you lose mental capacity. The attorney steps into your shoes and decides what treatment you receive, where you live, and how your daily care is managed. They are guided by your written preferences and the legal duty to act in your best interests, but they exercise judgment in the moment.

An Advance Decision to Refuse Treatment (ADRT) is a direct instruction from you, made while you have capacity, refusing specific medical treatments in defined future circumstances. No one exercises judgment — the document speaks for itself. If it is valid, applicable to the situation, and covers life-sustaining treatment with the required formalities, clinicians must follow it.

Which Document Takes Priority?

Under the Mental Capacity Act 2005, a valid and applicable ADRT overrides even a Health and Welfare LPA. If you have refused ventilation in specific circumstances through a properly executed ADRT, your health attorney cannot override that refusal — even if they believe ventilation would be in your best interests.

There is one exception: if the LPA was created after the ADRT, and the LPA gives the attorney specific authority over the treatment covered by the ADRT, the later LPA takes precedence. The sequencing matters.

This creates a practical question: should the two documents align, or is conflict inevitable? For most families, the answer is to create both documents together, ensuring the ADRT covers the treatments you feel most strongly about (often resuscitation, ventilation, and artificial nutrition) while the LPA gives your attorney flexibility for everything else. Your attorney should know the ADRT exists and understand what it covers.

The All Wales ADRT Form

NHS Wales uses its own standard template for Advance Decisions — the "All Wales Advance Decision to Refuse Treatment" form. This is not a legal requirement (any written document meeting the Mental Capacity Act criteria is valid), but using the standard NHS Wales template ensures that clinical teams recognise the document immediately and know how to apply it.

For an ADRT to be legally binding when it covers life-sustaining treatment, it must:

1. Be in writing
2. Be signed by the person making it (or signed on their behalf in their presence)
3. Be witnessed
4. Include a clear statement that the decision applies even if life is at risk

An ADRT that only covers non-life-sustaining treatments does not need to meet these formal requirements — it can technically be verbal — but writing it down and using the standard form removes any ambiguity when a clinical team needs to act under pressure at 3am.

Advance Statements Are Different Again

NHS Wales also uses the "All Wales Advance Statement of Wishes" form and integrated toolkits like Powys Teaching Health Board's "My Life, My Wishes" documents. These are not legally binding in the way an ADRT is. They record your preferences, values, and wishes — what kind of music calms you, whether you prefer to be at home, your spiritual or cultural needs during end-of-life care.

Clinicians must take advance statements into account as part of a best-interests assessment, but they are not required to follow them if clinical circumstances demand a different approach. An advance statement complements an ADRT and an LPA — it provides the human context that helps your attorney and medical team make decisions that feel right, not just legally correct.

Why You Probably Need Both

An LPA alone leaves gaps. If you lose capacity suddenly — a severe stroke, a traumatic brain injury — your attorney may not arrive at the hospital for hours. During that window, clinicians make treatment decisions without your attorney's input, relying on their own clinical judgment. A valid ADRT gives immediate, binding instructions that apply the moment the clinical team reads it, regardless of whether your attorney is present.

An ADRT alone has different gaps. It can only refuse treatments — it cannot request them, cannot choose between treatment options, and cannot make non-medical decisions like where you live or who provides your daily care. And it only covers the specific scenarios you anticipated when you wrote it. Medicine is unpredictable; your attorney handles everything else.

The practical approach: create a Health and Welfare LPA, draft an ADRT covering the treatments you feel strongest about, write an advance statement for your broader wishes, and make sure your attorney has copies of everything. Our Wales LPA toolkit includes guidance on coordinating all three documents so they work together rather than contradicting each other.

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