Advance decision or health and welfare LPA?
Guidance from Estate Advisory Group
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 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.
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.
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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