My Life, My Wishes: NHS Wales Advance Care Planning Explained

Advance care planning is the process of thinking about — and recording — your preferences for medical treatment and personal care in case you become too ill to communicate them yourself. In Wales, NHS trusts and healthcare teams use a specific framework called My Life, My Wishes (MLMW). It is not the same as the documents used by NHS England, and understanding what it is, what it covers, and how it differs from a Lasting Power of Attorney is essential for anyone in Wales who wants their wishes to be legally recognised.

What My Life, My Wishes actually is

My Life, My Wishes is a standardised advance care planning framework developed specifically for Wales by NHS Wales, in partnership with Welsh Government and third-sector organisations. It is used by community nurses, hospital teams, hospices, and GP practices across all seven Welsh health boards.

The framework contains two main components:

1. A Statement of Wishes and Feelings — a personalised, non-legally-binding document where you record your preferred place of care, your values, your cultural and linguistic preferences (including whether you want to be cared for in Welsh), the names of people who should be involved in decisions, and anything specific about your daily life that healthcare staff should know. This could include dietary requirements, religious observances, or a request that a specific family member be contacted first.

2. An Advance Decision to Refuse Treatment (ADRT) — a legally binding document where you state specific treatments you refuse in specific circumstances. An ADRT is binding on all clinicians in Wales and England under the Mental Capacity Act 2005, provided it meets the formal requirements. If the ADRT refuses life-sustaining treatment, it must be signed and witnessed.

My Life, My Wishes brings these two documents together into a single, nationally recognised format within Wales, making it easier for healthcare teams to locate and act on them across different settings.

How it differs from England's approach

In England, NHS trusts use a variety of advance care planning tools — some trust-specific, some developed by organisations like Hospice UK or the Gold Standards Framework. There is no single, mandated advance care plan format in England equivalent to MLMW in Wales.

This matters in practice. If a Welsh patient is transferred to an English hospital (for example, for specialist cardiac treatment in Bristol or oncology at a Birmingham NHS Trust), clinical teams there may not immediately recognise the MLMW documentation format. It is worth ensuring that any ADRT within the MLMW is clearly labelled as a legally binding document under the Mental Capacity Act, so that an unfamiliar team understands its legal status regardless of its Welsh formatting.

The reverse applies if a person normally resident in England is receiving care in Wales — an English advance care plan or ADRT is equally valid in Wales, as the Mental Capacity Act 2005 applies across England and Wales.

The Advance Decision to Refuse Treatment: legal requirements

A Statement of Wishes is persuasive but not legally binding. An ADRT refusing life-sustaining treatment is binding — but only if all the following conditions are met:

• You must have had mental capacity when you made it
• It must be in writing
• It must be signed by you (or at your direction if you cannot physically sign)
• It must be witnessed and signed by the witness
• It must include the statement: "This advance decision to refuse treatment applies even if my life is at risk as a result of refusing this treatment"

If any of these requirements are missing, the ADRT for life-sustaining treatment may not be legally binding. Clinical teams have discretion to treat in the best interests of the patient where there is doubt about validity.

For refusals of treatment that are not life-sustaining (for example, refusing a particular medication or a specific type of surgery), the formal witnessing requirement does not apply, though it remains good practice.

My Life, My Wishes versus a Lasting Power of Attorney

The MLMW framework and a Lasting Power of Attorney (LPA) are both planning tools but they serve distinct purposes. Understanding the difference matters because they interact with each other.

A Health and Welfare LPA gives a person you have appointed (your "attorney") the legal authority to make decisions about your care and medical treatment on your behalf, when you lack capacity. The attorney makes decisions — they do not simply record your wishes.

An ADRT within MLMW expresses your own refusal of specific treatments. When both exist, an ADRT takes precedence over an LPA if the ADRT expressly addresses the treatment in question. An attorney cannot override a valid ADRT.

A Statement of Wishes within MLMW is not legally binding on either clinicians or an LPA attorney — but both are legally required to take it into account when making best interest decisions.

The practical implication: if you want to refuse specific treatments, an ADRT is more powerful because it binds the clinical team directly. If you want someone to make broader care decisions on your behalf — including decisions about which hospital you go to, care home placements, or day-to-day welfare — an LPA for Health and Welfare is the appropriate instrument.

Many people in Wales benefit from having both: a Health and Welfare LPA for broad decision-making authority, and an ADRT within MLMW for specific treatment refusals.

LPA registration costs in Wales in 2026

Registering a Lasting Power of Attorney in Wales and England is handled by the Office of the Public Guardian (OPG). From November 2025, the registration fee is £92 per LPA document. There are two separate LPA documents — one for Health and Welfare, one for Property and Financial Affairs — so the combined cost for both is £184.

If your annual income is under £12,000, you may qualify for a 50% remission, reducing the cost per document to £46. If you are in receipt of certain means-tested benefits, the fee may be waived entirely. Apply for remission using form LPA120 when submitting your LPA registration.

LPAs cannot be used until they are registered with the OPG. Registration currently takes eight to twelve weeks. Do not wait until a health crisis to start this process.

How to complete My Life, My Wishes in Wales

The MLMW documentation is available through your GP surgery, community nursing team, or palliative care team. Ask your GP or district nurse for a copy. It can also be downloaded from the NHS Wales health board websites.

Once completed, copies should be:

• Kept by you or a family member in an accessible location (not locked in a safe)
• Shared with your GP for inclusion in your medical records
• Given to your community nursing team if you receive home visits
• Carried with you if you are frequently admitted to hospital

NHS Wales is working towards digital integration of MLMW documents across health board systems so that a plan created in Bangor can be accessed in Swansea. Until full integration is in place, paper copies shared proactively with your care team remain the most reliable approach.

The Wales Survivor Benefits Navigator includes advance care planning worksheets built specifically around the NHS Wales My Life, My Wishes framework — covering the Statement of Wishes, the ADRT requirements, and how to coordinate your MLMW documentation with an LPA. Get the complete toolkit at /uk/wales/survivor-benefits/.

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