Advance decisions and LPAs: Have your say in future care

When planning for your future medical care, making decisions now can offer control, clarity and peace of mind, for you and those close to you. Two of the most effective tools for this are advance decisions (sometimes known as living wills) and lasting powers of attorney (LPAs) for health and welfare.

While these are not easy conversations to have, putting the right legal documents in place means your wishes can be understood and followed, even if you’re unable to speak for yourself later on. Here’s what you need to know about each option and how they can protect your preferences and values.

What is an advance decision?

An advance decision is a legal document that allows you to refuse specific medical treatments in advance. It only comes into effect if you lose mental capacity to make or communicate decisions for yourself.

You might, for example, want to refuse life-sustaining treatment such as CPR, artificial ventilation or antibiotics in particular circumstances, such as if you’re in a permanently unresponsive state or at the end of life with no prospect of recovery.

The clearer your instructions, the more effective your advance decision will be. Once created, it should be placed on your medical records and shared with your loved ones or carers. Some people choose to carry a card or wear a bracelet to alert healthcare providers in an emergency.

When drafted and signed correctly, an advance decision is legally binding. It must be followed by healthcare professionals provided it applies to the situation at hand and hasn’t been overruled by a later LPA. In an emergency however, they must also act in line with their professional duty of care.

We recommend discussing your choices with a medical professional to ensure the wording is medically appropriate. A solicitor can then help you create a valid, legally recognised document.

What is a lasting power of attorney for health and welfare?

A health and welfare LPA allows you to appoint one or more trusted people - your “attorneys” - to make decisions on your behalf if you’re no longer able to. Unlike an advance decision, it can cover a broad range of everyday health and care decisions, including:

• Where you live and who provides your care
• Your personal routine, such as washing, dressing and eating
• Medical treatments and interventions
• Life-sustaining treatment, if you choose to give that authority

You can also express preferences in the LPA - for example, wanting to stay close to family or be cared for by a specific provider. While not legally binding, your attorneys are expected to take these into account when making decisions for you.

Should you have both?

In many cases, having both an advance decision and an LPA offers the most complete protection. Your advance decision gives clarity on specific treatments you want to refuse, while your LPA ensures someone you trust can step in to make other care decisions in your best interests.

If you choose to create both, it’s important to understand that the most recently made document will take precedence when it comes to life-sustaining treatment, unless your LPA clearly states that your advance decision should still stand. Your solicitor can help make sure both documents work together properly.

What happens if you have neither?

If you don’t have an advance decision or LPA in place, healthcare professionals will make decisions for you if you lose capacity. While they will usually consult your family and friends where possible, no one has legal authority unless formally appointed.

In the absence of close relatives or friends, an Independent Mental Capacity Advocate (IMCA) may be consulted or an application to the Court of Protection may be needed. This process can be time-consuming and emotionally difficult at an already stressful time.

Planning ahead

Thinking about your future care can feel overwhelming but by taking action now, you can protect your autonomy and ease the burden on your loved ones.

At LCF Law, we’re here to guide you through the process with sensitivity and expertise. Whether you’d like to create an advance decision, set up a health and welfare LPA or explore both, our team can guide you through the process.

To find out more or get started, contact Probate Practitioner Kathryn Livesey on 01943 885 798 or email ku.oc1780310643.fcl@1780310643yesev1780310643ilk1780310643

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