Advance decision or health and welfare LPA?
Guidance from Estate Advisory Group
Written and legally reviewed by Ramani Gill TEP, Solicitor and private client practitioner·Last reviewed 13 August 2026
One refuses specific treatment in advance. The other appoints a person to decide. The order you make them in matters.
The difference
| Advance decision | Health and welfare LPA | |
|---|---|---|
| What it does | Refuses named treatments in named circumstances | Appoints attorneys to decide |
| Can it consent to treatment? | No, refuse only | Yes |
| Registration | None | Must be registered with the OPG |
| Cost | Free to write | Our fee plus the £92 OPG registration fee |
| Flexible in unforeseen situations | No | Yes |
Which overrides which
The later document wins
A health and welfare LPA made after a valid advance decision, and which gives attorneys power over life-sustaining treatment, overrides the earlier refusal. An advance decision made after the LPA overrides the attorney on the treatments it covers. Date everything, and tell your attorneys and your GP what exists.
Having both
A common arrangement is a health and welfare LPA for day-to-day and unforeseen decisions, plus an advance decision for one or two specific refusals you feel strongly about. If you do this, say in the LPA that the advance decision stands, and give copies to your GP, your hospital and each attorney.
Take Priya, 74, who has a strong, long-held view that she never wants clinically assisted ventilation after a previous poor experience caring for her own mother. She writes a witnessed advance decision refusing ventilation in any circumstance, and separately makes a health and welfare LPA appointing her son as attorney with option A for everything else — resuscitation, other treatments, care decisions. Because both documents exist and are dated, her son knows exactly which decisions are already made for him and which are genuinely his to weigh up.
Why most people only need one
An advance decision is a narrow tool: it can only refuse treatment, it cannot consent to anything, and it only applies to the exact circumstances it describes. Write one that is too vague and clinicians may lawfully treat it as inapplicable to the situation actually facing them. A health and welfare LPA, by contrast, is built to flex — your attorney can respond to a scenario nobody anticipated when the form was signed. For most people making an LPA is the more useful document, and an advance decision is worth adding only where there is a specific, well-defined treatment you are certain you would refuse regardless of circumstances.
Keeping the documents consistent
- Store both documents where your attorneys and GP can find them quickly, not just in a solicitor's file.
- If you update one document, reread the other the same day to check they still agree with each other.
- Tell your attorneys about an advance decision even if you do not show them the exact wording immediately.
- Review both after any serious diagnosis, since views on treatment often shift once a condition becomes real rather than hypothetical.
Common questions
Does an advance decision have to be witnessed?
Only if it refuses life-sustaining treatment — then it must be written, signed and witnessed, and state that it applies even if life is at risk.
Can my attorney ignore my advance decision?
Not if it is valid, applicable and later than the LPA's authority over that treatment.
Can I write an advance decision myself without a solicitor?
Yes, provided you meet the formality requirements for decisions refusing life-sustaining treatment. Many people still ask a GP to keep a copy on file.
Does an advance decision expire?
No fixed expiry exists in law, but a document written many years ago, before a diagnosis it did not anticipate, may carry less weight — review it periodically.
Read next
Where this fits
This page is part of Health and care decisions. The pages below take it further.
- Health & Welfare LPA
The LP1H: care, treatment decisions and life-sustaining treatment.
- Make an LPA online
The whole journey end to end: questions, documents, signing and registration.
Review and sources
Reviewed by Ramani Gill TEP, Solicitor and private client practitioner. Last reviewed 13 August 2026. We recheck fees, forms and Office of the Public Guardian guidance whenever they change — see our editorial policy.
Official sources
Most people make both LPAs
Property & Financial Affairs and Health & Welfare together cost £79 instead of £98 separately.
The Office of the Public Guardian charges a separate £92 to register each LPA.
This is general information about how Lasting Powers of Attorney work in England and Wales. It is not legal advice about your situation. What we do and do not do.
Published by Estate Advisory Group