LPAs and Advance Decisions: What You Need to Know
How a Health & Welfare LPA and an Advance Decision work together — and what happens when they appear to conflict.
Written by Anthony Dalton · Reviewed by James Tyrrell · Last reviewed
Many people setting up a Health and Welfare LPA wonder whether they also need an Advance Decision, or whether the LPA already covers everything. The short answer is that the two documents serve quite different purposes — and understanding that difference is important if you want your future wishes to be properly protected.
At a glance
- An Advance Decision (living will) records your own refusal of specific treatments; an LPA delegates health decisions to an attorney
- A valid Advance Decision overrides an attorney's decision for the specific treatment it covers
- An LPA made after an ADRT can override it only if the LPA expressly revokes it or is clearly inconsistent
- Many people benefit from having both documents, each covering different ground
Key point: A Health & Welfare LPA gives an attorney authority to make health decisions on your behalf. An Advance Decision records your own refusal of a specific treatment. Where the two cover the same treatment, your Advance Decision wins.
What Is an Advance Decision to Refuse Treatment?
An Advance Decision to Refuse Treatment (ADRT) — sometimes called a living will — is a legal document that lets you refuse a specific medical treatment in advance. It comes into effect only if you later lose the mental capacity to make that decision yourself. The framework is set out in the Mental Capacity Act 2005.
You must be 18 or over and have full mental capacity when you make an ADRT. You can refuse almost any medical treatment — including resuscitation, ventilation, artificial nutrition, blood transfusions, or surgery — as long as the refusal is specific enough for clinicians to know exactly when it applies.
The most important thing to understand is this: an ADRT captures your own decision about a specific treatment. You are not delegating anything to anyone else. You are making the decision now, for a future moment when you cannot speak for yourself.
How Is an Advance Decision Different from a Health & Welfare LPA?
A Health and Welfare LPA appoints an attorney to make health and welfare decisions on your behalf when you lack capacity. That attorney is expected to act in your best interests, taking into account your known wishes, feelings, and values — but they are exercising their own judgement on your behalf.
An ADRT works differently. It does not delegate anything. It records a specific refusal, and if the described circumstances arise, the refusal stands — regardless of what your attorney, your family, or your doctors might prefer at the time.
- Health & Welfare LPA — Appoints a named person to make a wide range of health and welfare decisions. Flexible and broad in scope.
- Advance Decision — Records your own refusal of one or more specific treatments in defined circumstances. Precise and direct.
- Both documents — Can coexist and complement each other, as long as you understand where each one applies.
When Do They Conflict — and Which Takes Priority?
A conflict arises when your attorney would consent to a treatment that your ADRT explicitly refuses. In that situation, the Mental Capacity Act 2005 is clear: a valid, applicable ADRT for a specific treatment overrides your attorney’s decision on that treatment. The donor’s own documented refusal takes precedence.
This matters in practice. If a clinician is presented with both a Health and Welfare LPA (where the attorney says yes to a treatment) and a properly made ADRT (where you have refused that same treatment), the clinician should follow the ADRT. The attorney has no authority to override it.
There is one important exception: if a Health and Welfare LPA made after the ADRT expressly revokes the ADRT, or if the terms of the LPA are clearly inconsistent with the ADRT, then the LPA may take precedence. This is why it is essential to review both documents together, and to be explicit about what you intend each one to cover.
What Makes an ADRT for Life-Sustaining Treatment Legally Valid?
If your ADRT refuses life-sustaining treatment — such as CPR, mechanical ventilation, or artificial nutrition and hydration — it must meet stricter requirements than a general treatment refusal. These requirements exist because the stakes are high, and clinicians need to be certain the refusal is genuine and fully informed.
Must be in writing
A verbal refusal of life-sustaining treatment is not legally binding. Put it in writing, clearly and specifically.
Signed by you (or at your direction)
You must sign it yourself, or direct someone else to sign it in your presence if you are physically unable to do so.
Witnessed and counter-signed
A witness must be present when you sign and must sign the document themselves. The witness cannot be your attorney.
Explicit life-risk statement
The document must contain a clear statement that the refusal applies even if your life is at risk as a result.
Without all four elements, an ADRT refusing life-sustaining treatment is not legally binding — though clinicians will still consider it as strong evidence of your wishes when making best-interests decisions.
For treatments that are not life-sustaining, you do not need a written ADRT — but putting it in writing is always the right approach. Disputes are far less likely when wishes are documented clearly.
When to Use Both — and Why That Gives Maximum Protection
The most straightforward guidance is this: use an ADRT for specific treatments you are certain you would never want in defined circumstances. Use a Health and Welfare LPA for everything else — giving your attorney the authority to make a wide range of health and welfare decisions on your behalf when you cannot.
Used together, they complement each other. Your attorney handles the day-to-day decisions and complex judgements. Your ADRT takes specific treatments completely off the table, no matter what anyone else thinks at the time.
Without a Health and Welfare LPA, there is no one with formal legal authority to make the full range of health and welfare decisions for you — and if your ADRT does not cover a particular situation, medical staff will need to make best-interests decisions without a named person to consult. That is a significant gap.
Example: Margaret’s Approach
Margaret has been clear for years that she would not want chemotherapy if she reached a point where treatment would only prolong dying rather than offer a realistic prospect of recovery. She makes an ADRT documenting that refusal, with precise wording describing the circumstances.
She also makes a Health and Welfare LPA appointing her daughter as attorney, giving her authority over all other health decisions — where Margaret is cared for, pain management, physiotherapy, and decisions about day-to-day welfare. If Margaret later loses capacity, her daughter cannot consent to the chemotherapy Margaret’s ADRT refused. But she can make every other health and welfare decision Margaret’s ADRT does not cover.
Practical Steps If You Want Both Documents
- Tell your attorney about your ADRT — They should know it exists, where to find it, and exactly what it covers, before they ever need to act on your behalf.
- Store both documents together — Keep them in the same place, and tell the people who need to know where that is. Include your GP surgery, solicitor, and any hospital you attend regularly.
- Register your ADRT with your GP — Ask for it to be flagged on your medical record so that clinical staff are aware of it.
- Review them together periodically — If you update one document, check whether the other needs updating too. Circumstances change.
- Be specific in your ADRT — Vague wording creates uncertainty. If you are refusing a specific treatment, name it, describe the circumstances, and leave no room for interpretation.
- Consider legal advice for complex refusals — If your ADRT involves life-sustaining treatment, a solicitor can help ensure the wording meets the legal requirements under the Mental Capacity Act 2005.
Key point: Making both documents does not mean one cancels the other. They can work in parallel, each covering different ground. The key is being clear, specific, and ensuring both are accessible when needed.
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Key Takeaways
- Different purposes — an ADRT records your own specific treatment refusals; a Health and Welfare LPA delegates broad decision-making authority to a trusted person
- ADRT wins on specific treatments — where both documents cover the same treatment, the Advance Decision takes precedence under the Mental Capacity Act 2005
- Strict requirements for life-sustaining refusals — an ADRT refusing life-sustaining treatment must be written, signed, witnessed, and include an explicit life-risk statement
- Use both for maximum protection — the ADRT handles specific treatment refusals while the LPA attorney covers everything else
- Review both documents together — if you update one, check whether the other needs updating to avoid unintended conflicts
Common Questions About LPAs and Advance Decisions
Can an attorney override an Advance Decision?
No. A valid and applicable Advance Decision to Refuse Treatment takes precedence over an attorney’s decision for that specific treatment. The Mental Capacity Act 2005 is clear on this point. The attorney has authority over everything else, but not over a treatment the donor has already formally refused.
Does an LPA cancel an Advance Decision?
Not automatically. A Health and Welfare LPA made after an ADRT can override it if the LPA expressly revokes the ADRT, or if the terms of the LPA are clearly inconsistent with it. If you want both to stand, make that intention explicit in writing and keep both documents current.
Do I need both an LPA and an Advance Decision?
You are not required to have both, but many people benefit from using them together. An ADRT handles specific treatment refusals directly — no delegation involved. A Health and Welfare LPA covers the full range of health and welfare decisions where you want someone trusted to exercise judgement on your behalf.
What makes an Advance Decision legally valid?
You must have mental capacity and be 18 or over when you make it. For a refusal of life-sustaining treatment specifically, the ADRT must be in writing, signed by you (or someone at your direction), witnessed and signed by a witness, and must contain a clear statement that the refusal applies even if your life is at risk as a result.
This guide was last reviewed and updated on . Information is based on current legislation and OPG guidance for England and Wales.
Official Guidance
Government guidance on GOV.UK
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