Life-sustaining treatment: option A or B

What the two options mean

Life-sustaining treatment means anything a doctor considers necessary to keep you alive — ventilation, resuscitation, clinically assisted nutrition and hydration, sometimes antibiotics or surgery. Section 5 of the LP1H form is the only place in the whole document where a single tick decides who ultimately has the final say on this question, so it is worth reading slowly rather than defaulting to whichever option a template suggests.

How to think about it

• Choose option A if you trust a specific person to speak for you and you have talked to them about what you would want.
• Choose option B if you would rather clinicians decide, or you do not want to place that burden on your family.
• Either way, tell your attorneys what matters to you. The form does not carry your reasoning; conversation does.
• You can add a preference about your values without turning it into a binding instruction.

Consider Raymond, 68, who appoints his daughter Fiona as his sole health and welfare attorney. Raymond ticks option A because he trusts Fiona to weigh up a realistic prognosis rather than fight for treatment regardless of the outcome. In the preferences section he adds a short note that he would not want prolonged ventilation with little prospect of recovering independence. That sentence never overrides a doctor's clinical judgement, but it gives Fiona something concrete to say in a difficult meeting rather than guessing what her father would have wanted.

Why the choice is not really about trust in doctors

People sometimes frame option B as 'letting the professionals decide', as though option A hands the decision to an amateur instead. That is not quite right. Doctors always decide whether a treatment is clinically appropriate and likely to work — no attorney can demand treatment that a clinician judges futile, under either option. The real difference is who applies the best-interests test once a treatment is genuinely on the table: your attorney, informed by everything they know about you, or the treating team, informed only by what is in your medical notes and whoever they choose to consult. Many people choose option A precisely because they want someone who knew them well in the room, not because they distrust medicine.

Getting it right on the form

If you make more than one health and welfare LPA over your lifetime — for example, updating an older document — check that the option you tick each time is the one you currently mean. A later LPA that repeats an outdated option A because a template was copied without thought is a real risk, and it is the kind of error that is hard for anyone but you to spot before signing. A checked for common completion errors review before you send the form to the Office of the Public Guardian catches an unticked or double-ticked box, but it cannot tell you which option reflects your wishes — only you and your attorneys can settle that in conversation beforehand.

What happens if you never make this choice

Without a registered health and welfare LPA at all, nobody has the legal authority to make this decision on your behalf in either direction. Clinicians still apply the Mental Capacity Act's best-interests test and still consult family, but there is no single person the law recognises as having the final say, and disagreements between relatives are far more likely to end up in front of the Court of Protection. Making the health and welfare LPA alongside a property and financial affairs one closes that gap while you still have capacity to choose.

Common questions

Read next

• LP1H explained: the health and welfare LPA form
• Advance decision (living will) or health LPA?
• What can a health and welfare attorney actually decide?