Can an LPA Refuse Life-Saving Treatment?
The answer depends on one crucial tick-box — and most people don’t realise how much is at stake.
Written by James Tyrrell · Reviewed by Anthony Dalton · Last reviewed
A Health and Welfare LPA can give your attorney the power to refuse life-saving treatment — but only if you deliberately grant that authority when setting up the LPA. It doesn’t happen automatically. Whether you choose to tick that box or leave it blank, understanding what you’re deciding is one of the most important choices you’ll make in the whole process.
At a glance
- A Health and Welfare LPA only covers life-sustaining treatment if the donor specifically ticked that option in the LPA form.
- Without that authority, attorneys cannot refuse life-saving treatment — those decisions stay with medical professionals.
- An Advance Decision (living will) is an alternative way to refuse specific treatments and does not require an attorney.
- If both an LPA with life-sustaining treatment authority and an Advance Decision exist, the more recent document generally takes precedence.
The Life-Sustaining Treatment Option in a Health and Welfare LPA
When you create a Health and Welfare LPA, you reach a section that asks whether your attorneys should have the power to make decisions about life-sustaining treatment. You must actively choose whether to grant this authority. If you do not tick the box, the default position applies: your attorneys have no say over treatments designed to keep you alive.
Life-sustaining treatment includes things like resuscitation, ventilation, clinically assisted nutrition and hydration, and other interventions intended to prolong life. These are not everyday medical decisions — they arise in serious circumstances where you are unlikely to be able to communicate your wishes yourself.
What Happens Without the Life-Sustaining Treatment Box Ticked?
If the box is left unticked, your attorneys can still make most health and welfare decisions on your behalf — but not this one. In practice, clinicians will make life-sustaining treatment decisions based on your best interests under the Mental Capacity Act 2005, taking account of your known wishes and views where possible.
Your attorney can still be consulted as part of the best interests process. They can share what they know about your values, preferences, and what you would have wanted. But they cannot formally instruct doctors to withhold or withdraw treatment.
Key point: Not ticking the box does not mean your views will be ignored — it means the final decision stays with the medical team, guided by your best interests. Ticking the box hands that final authority to your attorney.
Can an Attorney Refuse a Specific Treatment?
Where the life-sustaining treatment authority has been granted, your attorney can refuse a specific treatment — for example, refusing resuscitation or declining a particular operation. They must act in your best interests, which means taking account of your past and present wishes, your values, and the views of people who know you well.
An attorney with this authority cannot demand that treatment be withdrawn simply because they want to. They must genuinely believe it reflects what you would have wanted and what is in your best interests. If a clinician believes the attorney is not acting properly, they can challenge the decision and seek a ruling from the Court of Protection.
LPA vs Advance Decision for Life-Sustaining Treatment
An Advance Decision to Refuse Treatment (sometimes called a living will) works differently from an LPA. Rather than delegating authority to an attorney, it allows you to specify in advance exactly which treatments you wish to refuse in which circumstances. An Advance Decision does not require an attorney and does not depend on someone else making a judgement call.
LPA with life-sustaining authority
Gives your attorney flexibility to make treatment decisions in light of actual circumstances at the time. Relies on their judgement and understanding of your wishes. Covers a wide range of decisions.
Advance Decision to Refuse Treatment
A written statement refusing specific treatments in defined circumstances. More precise, but less flexible. Must be signed, witnessed and must specifically address life-sustaining treatment to be valid for it.
Many people choose to have both: a Health and Welfare LPA for general decisions, and an Advance Decision for any specific treatments they feel strongly about. If they conflict, the more recent document usually takes priority — but seek legal advice if you want to use both.
Should You Give Your Attorney This Authority?
There is no universally right answer. Some people find it reassuring to know their attorney can step in fully if things reach that point. Others prefer that doctors retain control, perhaps adding their wishes through an Advance Decision instead.
A few things worth thinking through:
- Does your attorney understand your values well enough to make this call on your behalf?
- Have you had a frank conversation with them about what you would and would not want?
- Are you comfortable with the idea of one person holding this level of authority?
- Would you prefer to set out your wishes in writing through an Advance Decision instead?
Writing your wishes into the preferences section of your LPA — whether or not you tick the box — helps ensure those who care for you understand what you value, even if they do not have binding authority over this specific decision.
What Doctors Must Do When an LPA Covers Life-Sustaining Treatment
Where an attorney has been granted life-sustaining treatment authority, healthcare professionals must treat their decision with the same weight they would give to a patient’s own refusal. They cannot simply override it because they disagree. That said, doctors have a right to seek clarification, and if they believe an attorney is not acting in the donor’s best interests, they can apply to the Court of Protection.
In practice most decisions are reached by agreement. Hospitals and clinical teams work with attorneys, respecting the donor’s known wishes wherever possible.
Key Takeaways
- Not automatic — a Health and Welfare LPA only covers life-sustaining treatment if the donor explicitly granted that authority in the LPA.
- Without the authority — clinicians make life-sustaining treatment decisions based on best interests, though attorneys are consulted as part of that process.
- Attorneys must act in best interests — even with full authority, attorneys cannot make arbitrary decisions and must act in line with the donor’s wishes and values.
- Advance Decisions are an alternative — a signed, written Advance Decision to Refuse Treatment can refuse specific treatments without requiring an attorney.
- Conflict rules — if both an Advance Decision and an LPA exist covering the same treatment, the more recently made document generally takes precedence.
Common Questions About LPAs and Life-Saving Treatment
Can a Health and Welfare LPA be used to refuse life-saving treatment?
Only if the donor specifically granted that power when creating the LPA. There is a tick-box in the Health and Welfare LPA that allows attorneys to make decisions about life-sustaining treatment. If this box was not ticked, attorneys cannot refuse life-saving treatment on the donor’s behalf.
What is the difference between an LPA and an Advance Decision for life-saving treatment?
An Advance Decision is a specific written statement of your wishes to refuse particular treatments in defined circumstances. An LPA delegates authority to a named attorney. If both exist and conflict, a valid Advance Decision made after the LPA takes priority. If made before, the LPA overrides it unless the LPA specifically confirms the Advance Decision.
Can a doctor ignore an LPA attorney’s refusal of life-saving treatment?
Where the attorney has been given life-sustaining treatment authority, doctors must generally follow their decision. However, if a doctor believes the attorney is not acting in the donor’s best interests, they can apply to the Court of Protection for a ruling. In genuine emergencies, treatment may be given while a court decision is sought.
Should I give my attorney life-sustaining treatment authority in my LPA?
This is a deeply personal decision. Some people want their attorney to have full authority, including the ability to refuse treatment. Others prefer that doctors always have the final say. Neither choice is wrong — the key is discussing your wishes with your attorney and, if helpful, writing your preferences into the LPA or creating an Advance Decision.
This guide was last reviewed and updated on . Information is based on current legislation and OPG guidance for England and Wales.
Official Guidance
Official resources from GOV.UK
Take the First Step Today
Creating an LPA is one of the most important things you can do for yourself and your family.
