Health & Welfare LPA

Money and property have their own LPA. This one covers everything else: the personal side, the medical side, the "how do I want to live" side. Your attorney under a Health and Welfare LPA has the power to make choices about your day-to-day existence and your medical care when you're no longer able to make them yourself.

What kind of choices? Everything from the small stuff (meals, bedtime, whether you join the Thursday bingo session at the care home) to the weighty stuff (agreeing to surgery, picking a residential placement, accepting or declining a course of treatment). And at the far end of the spectrum sits one question that stops most people in their tracks: should your attorney have a say over whether life-sustaining treatment continues? We'll come back to that.

Here's the critical difference from the financial version: this LPA stays dormant until you actually lose mental capacity. While you can still think clearly and communicate your wishes, your attorney has no power to override you. Parliament baked that protection into the 2005 legislation deliberately.

What surprises many people is that capacity isn't a simple on/off switch. A person can lack the ability to weigh up a complicated surgical decision while being perfectly capable of saying whether they fancy fish or chicken for dinner. Healthcare professionals assess it one decision at a time, and your attorney only takes over for the specific decisions you can no longer make. If they conclude you can't make the specific decision at hand, your attorney steps in for that decision.

People slow right down when they reach this section, and rightly so. The question on the form is stark: should your attorney have authority over decisions about starting, continuing, or switching off treatment that's keeping you alive?

Ventilators. Resuscitation. Dialysis machines. Feeding tubes. These are the kinds of interventions at stake, the ones that keep a body going when it can no longer sustain itself. The question is whether your attorney should have the final say on these interventions if you're unable to express your own wishes.

You have three choices. You can grant your attorney that authority, which gives them the widest possible power to act on your behalf. You can withhold it, which means doctors follow their own clinical judgement on life-sustaining matters while your attorney handles everything else. Or you can add specific preferences and conditions that guide the decision without delegating it entirely.

There's no right answer here. Some people feel strongly that their partner or child should make that call. Others feel more comfortable leaving clinical teams to use their own professional judgement on these questions. Neither position is wrong. What would be wrong is never thinking about it at all and leaving everyone guessing.

Most of us need a wake-up call before we act. A parent's memory starts slipping. A colleague half your age ends up in intensive care. A relative spends six months battling the Court of Protection. Once reality intrudes, the "I should probably sort that out" feeling becomes impossible to shake. But the best time to make one is years before you need it.

Without a Health and Welfare LPA, doctors make treatment decisions based on their clinical assessment of your best interests. They'll consult your family where possible, but your relatives have no formal legal say. They can express opinions and share information about your wishes, but the medical team isn't bound by those views.

That's a hard thing for families to accept. Your daughter might know perfectly well that you wouldn't want to be kept on a ventilator, but without an LPA granting that authority, she can't make it happen. The doctor decides, not her.

A Court of Protection application is the only alternative, and by the time someone is making critical healthcare decisions, there's rarely time for a process that takes months.

Your attorney can consent to or refuse medical treatment (subject to your choices about life-sustaining treatment). They can decide where you live, including choosing a care home or supported living arrangement. Daily care falls under their remit too: meals, exercise, what you wear, social activities, and they can request access to your medical records. They can decide who you have contact with, though this must always be in your best interest.

They cannot make decisions you're still capable of making yourself. They cannot override an advance decision (living will) you've already made. Detention under the Mental Health Act brings separate rules that an LPA doesn't override. And underpinning everything is the Mental Capacity Act's core principle: capacity is always assumed unless there's evidence otherwise, and every decision must be made in your best interest.

The two get muddled up regularly. An advance decision (you might hear it called a living will) is a standalone document in which you refuse particular treatments before the situation arises. When properly made, it's legally binding on the clinical team.

An LPA is broader. It covers all health and welfare decisions, not just treatment refusals. And it gives a real person the flexibility to respond to circumstances as they unfold, which a static advance decision can't do.

You can have both. Some people make an advance decision about specific treatments they know they'd refuse, while also appointing an attorney through an LPA to handle everything else.

Our online tool breaks the process into manageable steps with straightforward language throughout. You set out your views on life-sustaining treatment, appoint your attorneys, and note anything else you'd want taken into account. The output is a finished LPA that just needs signing and posting to the OPG.