Health and Welfare LPA: Complete Guide to Healthcare Decisions

A Health and Welfare LPA is one of the most important documents you can create, yet it's often overlooked in favour of its financial counterpart. This LPA covers decisions about your medical treatment, daily care, and where you live – the most personal decisions anyone could make on your behalf.

If you lose the ability to make these decisions for yourself, someone will make them for you. The question is: do you want to choose who that person is, or leave it to chance?

What is a Health and Welfare LPA?

A Health and Welfare Lasting Power of Attorney is a legal document that lets you appoint someone to make decisions about your health, medical treatment, and personal care if you become unable to make these decisions yourself.

Unlike a Property and Financial Affairs LPA, a Health and Welfare LPA can only be used when you lack capacity to make the specific decision in question. While you still have capacity, you make your own healthcare decisions – your attorney can't override you.

What Decisions Does It Cover?

Your attorney can make decisions about:

Medical treatment:

• Consenting to or refusing medical treatment
• Choosing between treatment options
• Deciding about medications
• Making decisions about surgery
• Consenting to diagnostic tests

Daily care:

• What you eat and drink
• What you wear
• Your daily routine
• Personal hygiene and grooming

Where you live:

• Whether you stay at home
• Whether you move in with family
• Whether you move into a care home
• Which care home you go to

Social decisions:

• Who you have contact with
• Social activities
• Day-to-day lifestyle choices

What it doesn't cover:

• Decisions about your finances (that's the Property and Financial LPA)
• Voting in elections
• Consenting to marriage or civil partnership
• Consenting to divorce
• Consenting to sex
• Making a will for you

When Can It Be Used?

Your Health and Welfare LPA can only be used when you lack mental capacity to make the specific decision in question. Capacity is assessed for each decision individually – you might have capacity to decide what to eat but lack capacity to consent to complex surgery.

The key test is whether you can:

• Understand information about the decision
• Retain that information long enough to make the decision
• Weigh up the information to make a decision
• Communicate your decision

If you can do all four things, you have capacity for that decision, and your attorney cannot make it for you – even if they disagree with your choice.

Healthcare professionals will assess capacity before involving your attorney. For day-to-day decisions, care staff may make the assessment. For complex medical decisions, a doctor will.

Life-Sustaining Treatment

One of the most significant decisions in any LPA is whether you give your attorney authority over life-sustaining treatment.

What is life-sustaining treatment?

Treatment that is intended to sustain or prolong life. Examples include:

• Ventilators (breathing machines)
• CPR (cardiopulmonary resuscitation)
• Artificial nutrition and hydration (tube feeding)
• Chemotherapy
• Dialysis
• Blood transfusions
• Antibiotics in life-threatening infections

The option you must choose:

When making your LPA, you must decide whether to give your attorney authority to consent to or refuse life-sustaining treatment on your behalf. You have two choices:

Option A - Give authority: Your attorney can make decisions about life-sustaining treatment, including refusing it if they believe that's in your best interests.

Option B - Don't give authority: Your attorney cannot refuse life-sustaining treatment on your behalf. Doctors will make these decisions based on your best interests.

This is one of the most important decisions you'll make. Discuss it thoroughly with your chosen attorney and make sure they understand your wishes.

Choosing Your Attorney

For Health and Welfare decisions, your attorney should be someone who:

Knows you well:

• Understands your values and beliefs
• Knows what quality of life means to you
• Can make decisions you would make if you could

Can handle difficult situations:

• Comfortable discussing medical matters
• Able to stand firm with healthcare professionals if needed
• Can handle family disagreements

Is available:

• Lives close enough to attend appointments
• Has time to be involved in your care
• Likely to be around when needed

For many people, this is a spouse, adult child, or close sibling. The person you choose for your Health and Welfare LPA might be different from your Property and Financial LPA – consider who is best suited to each role.

Instructions and Preferences

You can include instructions (which attorneys must follow) and preferences (which guide their decisions) in your LPA.

Useful preferences to include:

• "I would prefer to stay in my own home as long as safely possible"
• "I would prefer to receive care in an English-speaking environment"
• "I would like to continue attending [religious institution] if possible"
• "I do not want to be kept alive artificially if there is no reasonable prospect of recovery"
• "I would prefer hospice care to aggressive treatment for terminal illness"

Useful instructions to include:

• "My attorney must consult with [specific person] before making major medical decisions"
• "I do not wish to receive blood transfusions for religious reasons"

Be careful not to make instructions too rigid – circumstances change, and overly specific instructions can make it impossible for your attorney to act in your best interests.

Health and Welfare vs Property and Financial

The two types of LPA are complementary:

Property and Financial Affairs:

• Covers money, property, finances
• Can be used while you still have capacity (if you specify)
• Deals with banks, bills, investments

Health and Welfare:

• Covers health, care, lifestyle
• Can only be used when you lack capacity
• Deals with doctors, care homes, daily care

Most people set up both. The financial LPA is useless if no one can consent to your medical care. The health LPA is useless if no one can pay for your care. Together, they provide comprehensive protection.

You can choose different attorneys for each LPA. For example, you might want your spouse to handle health decisions (they know you best) but a more financially savvy child to handle finances.

Common Questions

Can my attorney put me in a care home against my will?

Only if you lack capacity to make that decision. If you have capacity, you decide where you live. If you lack capacity, your attorney must act in your best interests, which might include a care home if you need care you can't safely receive at home.

What if doctors disagree with my attorney?

Doctors must respect your attorney's decisions if they're within the LPA's scope and in your best interests. However, doctors can refuse to provide treatment they consider futile or inappropriate. Disputes can be referred to the Court of Protection.

Can I have different attorneys for health and financial matters?

Yes. Many families choose the person best suited to each type of decision. Someone who's great with finances might not be the best person to make emotional healthcare decisions, and vice versa.

What if I already have an Advance Decision (Living Will)?

An Advance Decision refusing specific treatments takes precedence over your attorney's authority. Your attorney cannot consent to treatment you've refused in a valid Advance Decision. The documents work together – the Advance Decision handles specific refusals you've thought about in advance, while your attorney handles everything else.