What Happens If You Don't Have an Advance Directive in Wales

Doctors Decide for You Under the Best-Interests Framework

When a person in Wales loses mental capacity — from a stroke, advanced dementia, a sudden cardiac arrest, or a head injury — and has no Advance Decision to Refuse Treatment (ADRT) or Lasting Power of Attorney (LPA) in place, clinicians must fall back on the Mental Capacity Act 2005's "best interests" framework.

That framework requires doctors to consider everything they can reasonably ascertain about the patient's past wishes, values, and beliefs. They consult family members, friends, and carers. Then the clinical team makes the decision.

The problem is straightforward: consulting family is not the same as following your wishes. Your relatives can share what they think you'd want, but the final call belongs to the medical team. If your daughter says you wouldn't want to be ventilated and your son disagrees, the consultant makes the decision — often defaulting to the intervention that sustains life, because withholding treatment carries higher medicolegal risk than providing it.

The Treatments You Might Receive Against Your Wishes

Without a valid ADRT, there's no legal mechanism to stop clinicians from initiating treatments you may have verbally opposed for years. These commonly include:

• Cardiopulmonary resuscitation (CPR) — chest compressions, intubation, and electrical shocks. Survival rates for out-of-hospital cardiac arrest in the UK are around 8–10%, and among elderly patients with significant comorbidities, the rate drops further. Even survivors often face fractured ribs and neurological damage.
• Invasive mechanical ventilation — connection to a breathing machine in an intensive care unit, potentially for weeks or months.
• Clinically assisted nutrition and hydration (CANH) — artificial feeding through a nasogastric tube or PEG tube, which can sustain biological life long after meaningful consciousness has gone.
• Dialysis and IV antibiotics — extending the dying process in patients with terminal organ failure.

If you'd told your family "I don't want any of that," but never wrote it down in a witnessed, signed ADRT that specifically names the treatments and circumstances, your spoken wishes are evidence the team must consider, but they do not have the binding force of an ADRT.

Your Family Gets Consulted, Not Empowered

This is the part that catches most Welsh families off guard. Under the Mental Capacity Act 2005, family members have no automatic decision-making authority. They are consulted as part of the best-interests assessment, but they cannot consent to or refuse treatment on your behalf — unless they hold a registered Health and Welfare LPA that explicitly grants authority over life-sustaining treatment.

Without that LPA, the family's only recourse if they disagree with the clinical team's decision is to apply to the Court of Protection. That process costs upwards of £5,000, takes months, and is resolved by a judge rather than anyone who knows you personally.

The Financial Consequences Compound

The absence of advance planning doesn't just affect treatment decisions. It cascades through the administrative aftermath:

• No LPA for Property and Financial Affairs means nobody can access bank accounts, pay bills, sell property, or manage investments. The family must apply for a deputyship — a process that can cost upwards of £5,000 and may include ongoing OPG supervision fees.
• Frozen joint accounts leave the surviving partner unable to pay household bills or care home fees.
• Delayed estate administration extends the period when property sits empty, council tax accrues, and insurance policies may lapse.

If the estate is valued above £5,000, the probate application fee is £526. Clean digital applications take 2–5 weeks; applications with errors — mismatched names, incomplete executor details — get "stopped" and can sit in a separate queue for 15–20 weeks, compounding the financial pressure.

What an ADRT Actually Prevents

A valid ADRT, drafted under the Mental Capacity Act 2005, is legally binding on clinicians in Wales. It lets you refuse specific treatments under specific circumstances — and doctors must follow it, provided it meets the statutory requirements:

1. You had mental capacity when you made it
2. It names the specific treatments you refuse
3. It describes the circumstances under which the refusal applies
4. If it covers life-sustaining treatment, it includes the statement "even if my life is at risk or may be shortened as a result," and is signed, dated, and witnessed

When an ADRT is uploaded to the Welsh Clinical Portal via your GP surgery, emergency teams can find it through the "Future Care Plan discussed" flag.

The Window Closes Without Warning

The reason advance planning matters is that you need mental capacity to do it. You can't sign an ADRT or an LPA after a stroke has left you unable to understand what you're signing. An early dementia diagnosis doesn't automatically remove capacity — there's often a window of months or years where the person can still make legally valid decisions — but that window can close after a single bad night.

Our Wales ADRT planning guide covers every step: which treatments to name, how to word refusals so clinicians can't question their validity, witness requirements, GP registration for the Welsh Clinical Portal, and coordination with an LPA so neither document accidentally overrides the other.

The alternative — no plan, no document, no legal standing — is a best-interests meeting where strangers decide what happens to your body.

Get the complete planning kit and close the gap before it's closed for you.

See more Wales guides →