Life-Sustaining Treatment and Your Health & Welfare LPA

Written by Anthony Dalton · Reviewed by James Tyrrell · Last reviewed 9 April 2026

When you create a Health and Welfare LPA, you are asked a question that many people find difficult: should your attorney have the authority to make decisions about life-sustaining treatment on your behalf? There is no right or wrong answer. But understanding what this option means, and talking it through with the people closest to you, can make the decision much clearer.

What Is Life-Sustaining Treatment?

Life-sustaining treatment is any medical treatment that keeps a person alive. It is not limited to dramatic interventions — it covers a wide range of procedures that doctors might use when someone is seriously unwell or nearing the end of their life.

Under the Mental Capacity Act 2005, life-sustaining treatment includes:

• Mechanical ventilation — a machine that breathes for you when you cannot breathe on your own
• Cardiopulmonary resuscitation (CPR) — attempts to restart the heart and breathing
• Artificial nutrition and hydration — feeding through a tube when you can no longer eat or drink
• Blood transfusions — replacing lost blood during illness or surgery
• Antibiotics for life-threatening infections — medication to treat infections that could otherwise be fatal

What counts as life-sustaining treatment depends on the circumstances. An antibiotic prescribed for a chest infection might not normally be considered life-sustaining, but for someone with a serious underlying condition, that same antibiotic could be the difference between life and death.

The Life-Sustaining Treatment Option in Your LPA

When you create a Health and Welfare LPA, the form asks you to choose one of two options regarding life-sustaining treatment. These are sometimes referred to informally as “Option A” and “Option B”:

This is a mandatory choice. You cannot leave it blank — the Office of the Public Guardian will not register your LPA without an answer. Both options are valid, and neither is “better” than the other. What matters is which one is right for you.

What Happens if You Give Your Attorney This Authority

If you choose Option A, your attorney gains the legal authority to consent to or refuse life-sustaining treatment on your behalf — but only when you lack the mental capacity to make that decision yourself.

In practice, this means your attorney would be consulted by the medical team caring for you. They would be asked to consider what you would have wanted, taking into account your known wishes, values, and beliefs. Your attorney does not make this decision alone — they work alongside doctors, who provide clinical advice and information about your prognosis.

Giving your attorney this authority does not mean they will refuse treatment. Many people worry about this. The reality is that your attorney must act in your best interests, and in most situations, that means consenting to treatment that could save or prolong your life.

What it does give them is the right to be involved — to ask questions, challenge recommendations if appropriate, and ensure that decisions reflect what you would have wanted rather than a purely clinical judgement.

What Happens if You Do Not Give This Authority

If you choose Option B, your attorney can still make decisions about all other aspects of your health and welfare — where you live, your daily care, other medical treatments. But when it comes to life-sustaining treatment specifically, the decision rests with your medical team.

Doctors will make this decision in your best interests, taking into account your known wishes and consulting with your family where possible. That said, the final decision is a clinical one. Your attorney and family can share their views, but they do not have the legal authority to override the medical team’s judgement.

Talking to Your Family and Attorney About This Decision

This is not a decision to make in isolation. The person you appoint as your attorney needs to understand your values and what matters to you, especially around end-of-life care. If they are ever called on to make a decision about life-sustaining treatment, they need to feel confident about what you would have wanted.

These conversations can feel uncomfortable, but they are some of the most important ones you will ever have. Consider discussing:

• Your general views on quality of life versus length of life
• Whether there are specific treatments you would or would not want
• Your feelings about being kept alive on a ventilator or through artificial feeding
• Any religious or cultural beliefs that might affect treatment decisions
• How you feel about palliative care and pain management

You might also want to write down your wishes in the “preferences” section of your LPA, so your attorney has a written record to refer back to. These preferences are not legally binding in the same way as instructions, but they carry real weight and help your attorney understand what matters to you.

Life-Sustaining Treatment and Advance Decisions (Living Wills)

An advance decision (sometimes called a living will) lets you refuse specific medical treatments in advance. If it covers life-sustaining treatment, it must be in writing, signed, and witnessed. The relationship between an advance decision and an LPA can be confusing, so here is how it works:

• If your LPA was created after your advance decision, and gives your attorney authority over life-sustaining treatment, the LPA takes priority
• If your advance decision was made after your LPA, the advance decision takes priority for the treatments it covers
• If your LPA does not give your attorney authority over life-sustaining treatment, a valid advance decision about that treatment will still apply

The key is consistency. If you have both documents, make sure they do not contradict each other. Conflicting instructions can cause confusion and delay at exactly the time when clear guidance is most needed.

An LPA is generally more flexible than an advance decision because your attorney can respond to the actual situation at the time, rather than a scenario you predicted in advance. Our guide to LPAs and medical treatment explores this in more detail.

What Your Attorney Must Consider When Making These Decisions

If you give your attorney authority over life-sustaining treatment, they are bound by the principles of the Mental Capacity Act 2005. This is not a free hand — there are clear legal duties they must follow:

This Is a Deeply Personal Decision — There Is No “Right” Answer

Some people feel strongly that they want their attorney to have full authority over every health decision, including life-sustaining treatment. They trust that person to understand what they would have wanted and to work with doctors to make the best possible choice.

Others prefer to leave life-sustaining treatment decisions to the medical professionals. They may feel that this is too great a burden to place on a family member, or they may simply trust that doctors will act appropriately.

Both positions are entirely reasonable. What matters most is that you make a conscious, informed choice rather than ticking a box without thinking it through. Take the time to reflect, have the conversations, and choose the option that feels right for your situation.

How to Create Your Health and Welfare LPA

Creating a Health and Welfare LPA in England and Wales requires you to be aged 18 or over and to have the mental capacity to understand what you are doing. The process involves choosing your attorneys, deciding on the life-sustaining treatment option, having the document signed and witnessed, and registering it with the Office of the Public Guardian for a fee of £92.

You do not need a solicitor to create an LPA. Many people use an online service like ours, which walks you through the form step by step and checks for common errors before submission. Our step-by-step guide to making an LPA covers the full process.

If you are also considering a Property and Financial Affairs LPA, creating both at the same time is simpler and ensures there are no gaps in the decisions your attorneys can make.

Common Questions About Life-Sustaining Treatment and LPAs

This guide was last reviewed and updated on 9 April 2026. Information is based on current legislation and OPG guidance for England and Wales.

Back to Guides