Understanding Health and Welfare LPA and Advance Directives

Planning for the possibility that you may lose mental capacity is a kind, practical step you can take now to protect your medical wishes and personal care. Two tools used in England and Wales are the Health and Welfare Lasting Power of Attorney, and advance decisions or advance directives, sometimes called living wills. Each has a different role, and using them together can make your wishes clear when they matter most.

What is a Health and Welfare LPA?

A Health and Welfare Lasting Power of Attorney (LPA) lets you appoint one or more trusted people to make decisions for you about healthcare and daily care, if you later lose the capacity to decide for yourself. Decisions can include consent to or refusal of medical treatment, where you should live, and day to day matters such as diet and personal care.

How it works in practice

• Who you choose: You can appoint family, friends or a professional as your attorney. Consider naming replacement attorneys in case your first choices cannot act.
• When it takes effect: A Health and Welfare LPA only applies once a doctor or other relevant professional assesses that you lack the mental capacity to make a particular decision.
• Registration: You must register the LPA with the Office of the Public Guardian before it can be used. The current registration fee is £82 per LPA, unless you qualify for a fee exemption or remission.
• Legal duties: Your attorneys must act in your best interests, follow the Mental Capacity Act 2005, and keep clear records of important decisions.

What is an Advance Directive or Advance Decision?

An advance decision lets you refuse specific medical treatments in advance, in case you cannot communicate your choice later. In England and Wales the formal term is an advance decision to refuse treatment. It is especially useful if you know there are particular interventions you do not want, such as resuscitation or mechanical ventilation in defined circumstances.

Key points to know

• Specific and applicable: For an advance decision to be legally binding it must be clear, applicable to the situation, and made by someone with capacity at the time. You can make it verbally or in writing, but written, witnessed documentation is best for clarity.
• Healthcare teams must consider it: Medical professionals should follow a valid and applicable advance decision. For government guidance on advance decisions see gov.uk advance decisions.
• Not a decision maker: Unlike an LPA, an advance decision does not appoint someone to act for you. It is direct instructions for clinicians.

Can you have both documents?

Yes. Many people find it sensible to have both, because they serve different purposes. However, when both exist you need to be careful about how they interact. Generally, the most recent document that reflects your considered wishes will take precedence where there is conflict. If your advance decision refuses a treatment, your attorneys under a later Health and Welfare LPA may not be able to consent to that treatment. If you put an advance decision in place after appointing attorneys, your advance decision will normally override your attorneys on that specific refusal.

Practical tips when you are deciding

• Talk to the people you are considering appointing, so they understand your values and preferences before you need them to act.
• Be specific in any advance decision about the circumstances and treatments you are refusing, for example terminal illness or permanent unconsciousness.
• Keep copies of documents with your GP and family, and tell professionals where your LPA is registered with the Office of the Public Guardian.
• Review your documents regularly, especially after major life events like a diagnosis, marriage, or bereavement.

Example scenarios

If you do not wish to receive life-prolonging ventilation if you are in a permanent vegetative state, an advance decision can set that out clearly so clinicians know not to start that treatment. If you prefer someone close to you to make day to day welfare choices, such as moves into care or routine healthcare decisions, a Health and Welfare LPA gives them the legal authority to act.

Need help putting this in place?

Making an LPA can take time, because it must be signed, witnessed, and registered. If you want to set out refusals quickly, an advance decision may be faster to prepare in the short term. For help drafting either document and ensuring they work together as you intend, speak to Beneficial Family Wills. We offer a free, no obligation initial consultation to discuss your needs.

Arrange a Health and Welfare LPA with Beneficial Family Wills or talk to us about related estate planning to ensure your wider wishes are covered.

For quick advice or to book an appointment call 01522 500823 or contact us online. You can also explore our online will service for wills that work alongside your health planning.

If you would like official guidance from government sources, read more at gov.uk - Power of attorney and the advance decision page linked earlier.

Putting a Health and Welfare LPA and an advance decision in place gives you control over your future care, reduces family uncertainty, and helps professionals follow your wishes when you cannot speak for yourself.