Advance Decision and Living Will Wales: What They Are and How to Make One

An advance decision (sometimes called a living will) lets your parent refuse specific medical treatments in advance — treatments they wouldn't want if they later lose the ability to communicate their wishes. It's a legally binding document under the Mental Capacity Act 2005, and it applies in Wales exactly as it does in England.

This is different from an LPA, different from a DNACPR form, and different from general advance care planning — though they all interact. Here's how each one works.

Advance Decisions: Refusing Treatment in Advance

An advance decision allows a person to refuse specific medical treatments in circumstances they define. For example:

• "If I develop advanced dementia and can no longer recognise my family, I refuse artificial nutrition and hydration"
• "If I am in a persistent vegetative state, I refuse mechanical ventilation"
• "I refuse blood transfusions under any circumstances" (often made for religious reasons)

Key rules:

• The person must be 18 or over and have mental capacity when making the advance decision
• It must specify the treatment being refused and the circumstances in which the refusal applies
• It can only refuse treatment — it cannot demand specific treatments
• If it refuses life-sustaining treatment, it must be in writing, signed, and witnessed, and must include a statement that it applies "even if life is at risk"
• An advance decision that doesn't meet these requirements for life-sustaining treatment is not legally binding (though clinicians should still consider it)

Healthcare professionals must follow a valid advance decision. It overrides what family members want and what clinicians might recommend. A doctor who ignores a valid advance decision and administers the refused treatment could face legal action.

How an Advance Decision Interacts With an LPA

Here's where it gets complicated. If your parent has both a health and welfare LPA and an advance decision, the later document takes precedence.

• If the LPA was made after the advance decision, the LPA overrides it — the attorney has authority to consent to or refuse the treatment the advance decision covered
• If the advance decision was made after the LPA, the advance decision stands — the attorney cannot override it
• If it's unclear which was made later, or if they cover different treatments, both can coexist

This means the order in which these documents are created matters. If your parent wants their attorney to have full decision-making authority, they should make the LPA after any advance decision — or revoke the advance decision when creating the LPA.

DNACPR in Wales: The All Wales Policy

A Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision is not the same as an advance decision. In Wales, DNACPR is governed by the All Wales DNACPR Policy, which is a clinical decision — not a patient directive.

How it works:

• A senior clinician decides that CPR would not be successful or would not be in the patient's best interests
• The clinician must discuss this decision with the patient (if they have capacity) or with family and the health and welfare attorney (if they don't)
• The decision is recorded on the standardised All Wales DNACPR form
• The form travels with the patient — in hospital, in the care home, and at home

A patient can request a DNACPR decision through an advance decision or by telling their clinical team. But a DNACPR is ultimately a clinical judgment about whether CPR would work, not a unilateral patient choice.

If your parent has a health and welfare LPA, the attorney should be involved in any DNACPR discussion. If there's no LPA, the clinical team will consult family but make the final decision themselves.

Advance Care Planning: The Broader Conversation

Advance care planning (ACP) is the umbrella term for discussions and documents about future care preferences. In Wales, this includes:

• Advance decisions (legally binding refusals of treatment)
• Advance statements (written preferences about care — not legally binding, but clinicians must consider them)
• DNACPR decisions
• LPA health and welfare (the person's chosen attorney for future health decisions)
• Preferred priorities for care — where the person wants to be cared for, what matters most to them

Welsh local health boards and social services teams encourage ACP conversations, especially after a dementia diagnosis or when care needs are escalating. The Social Services and Well-being (Wales) Act 2014 requires care plans to reflect the individual's wishes wherever possible.

Making an Advance Decision

There's no official government form for an advance decision. It can be:

• Written on plain paper and signed
• Created using templates from organisations like Compassion in Dying or Age Cymru
• Drawn up with a solicitor's help

For refusing life-sustaining treatment, remember: it must be in writing, signed by the person making it, signed by a witness, and include the statement that it applies even if life is at risk.

Once made:

• Give a copy to the GP, who should add it to the medical records
• Give a copy to the health and welfare attorney (if there is one)
• Keep the original somewhere accessible — if paramedics or hospital staff can't find it in an emergency, they'll treat first and check later
• Review it periodically — advance decisions should be updated if circumstances change (new diagnosis, change of mind about specific treatments)

The Practical Priority

For most families in Wales managing an elderly parent's care:

1. Set up both LPAs first (property/financial + health/welfare) — these give your family day-to-day decision-making authority
2. Then consider an advance decision if your parent has strong feelings about specific treatments they'd refuse
3. Have the ACP conversation about broader care preferences — where they want to live, what quality of life means to them, what they'd want in different scenarios

The Wales Legal Authority Kit includes guidance on advance care planning alongside the LPA and deputyship processes — because legal authority and care wishes need to work together, not in isolation.

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