LPAs and End-of-Life Care Decisions
A Health and Welfare LPA is one of the most powerful tools you have for ensuring your end-of-life wishes are respected.
Written by James Tyrrell · Reviewed by Anthony Dalton · Last reviewed
End-of-life care is one of the most personal and sensitive areas where an LPA can make a profound difference. When someone is approaching the end of life and can no longer communicate their wishes, a Health and Welfare attorney steps into a deeply significant role — ensuring the person receives the care they would have chosen, in the place they would have preferred, with the dignity they deserve.
At a glance
- A Health and Welfare LPA covers palliative care decisions, hospice placement, and care setting choices at end of life.
- Attorneys can refuse non-life-sustaining treatment on the donor’s behalf.
- Life-sustaining treatment decisions require specific authority granted in the LPA.
- An Advance Decision to Refuse Treatment can work alongside an LPA for specific treatment refusals.
What End-of-Life Decisions Does an LPA Cover?
A Health and Welfare LPA gives an attorney authority over personal welfare and healthcare decisions when the donor lacks capacity. At end of life, this covers a wide range of choices:
Care setting decisions
Choosing whether the donor receives end-of-life care at home, in a hospice, or in hospital. For many people, this is among the most important decisions — most people say they would prefer to die at home or in a hospice, not a hospital.
Palliative care preferences
Decisions about symptom management, pain relief, and the level of medical intervention the donor would want. This includes agreeing to or declining particular medications or procedures.
Who is present
Decisions about who should be involved in care and who can visit, ensuring the donor is surrounded by the people they would have chosen.
Refusing non-essential treatment
An attorney can refuse treatment that will not provide benefit or that the donor would have rejected. This is different from refusing life-sustaining treatment, which requires specific authority.
The Life-Sustaining Treatment Question
At end of life, the most significant decisions often involve life-sustaining treatment — whether to continue or withdraw ventilation, artificial nutrition and hydration, or resuscitation. An attorney can only make these decisions if the donor explicitly gave them this authority when creating the LPA.
If this authority was not granted, the clinical team makes best interests decisions about life-sustaining treatment, consulting the attorney as part of that process. The attorney cannot formally consent to or refuse these interventions, but their knowledge of the donor’s wishes carries significant weight.
See our guide on Can an LPA refuse life-saving treatment? for a detailed explanation of this option.
Working Alongside an Advance Decision
An Advance Decision to Refuse Treatment and a Health and Welfare LPA can work together as part of a comprehensive end-of-life plan. The Advance Decision provides a specific, legally binding statement refusing defined treatments in defined circumstances. The LPA gives the attorney broader authority for the many decisions that fall outside a specific refusal.
Having both means you have maximum control over your end-of-life care:
- The Advance Decision handles specific treatments you know you would refuse (e.g. resuscitation in defined circumstances)
- The LPA gives your attorney authority to make the hundreds of other decisions that arise in end-of-life care
- The attorney can use the preferences section of the LPA to guide their decisions throughout
Key point: Talking to your attorney about your end-of-life wishes before they need to act is the single most valuable thing you can do. A written record of where you want to be, what level of intervention you want, and how you want to be cared for gives them the confidence to act on your behalf without doubt or hesitation.
What to Include in Your LPA for End-of-Life Planning
The preferences and instructions section of a Health and Welfare LPA is the right place to record your end-of-life wishes. Some things worth considering:
- Whether you would prefer to die at home, in a hospice, or in hospital if circumstances allow
- Your views on the level of medical intervention you want at end of life
- Who you would want to be present
- Any religious, cultural, or personal rituals that matter to you
- Whether you have written a separate Advance Decision and where it is kept
- Your views on pain management and sedation
These preferences are not legally binding instructions in the same way as an Advance Decision, but they are powerful evidence of your wishes and put your attorney in a much stronger position to act on your behalf.
When There Is No LPA at End of Life
Without a Health and Welfare LPA, end-of-life decisions default to the clinical team under the Mental Capacity Act best interests framework. Family members are consulted but have no binding authority. For decisions involving withdrawal of life-sustaining treatment, courts are often involved, adding legal proceedings to an already difficult time.
An LPA also means your chosen person can engage with the palliative care team, hospice, and hospital with clear legal authority — rather than being on the outside of decisions made by professionals who may not know the person’s wishes.
Key Takeaways
- Broad end-of-life authority — a Health and Welfare LPA covers palliative care choices, hospice placement, pain management decisions, and care setting at end of life.
- Life-sustaining treatment needs specific authority — decisions about withdrawing life support require this to have been granted explicitly in the LPA.
- Use the preferences section — recording end-of-life wishes in the LPA gives your attorney a clear mandate and ensures your wishes are documented.
- Combine with an Advance Decision — an Advance Decision to Refuse Treatment handles specific refusals; the LPA covers everything else.
- Without an LPA — end-of-life decisions go to the clinical team, with family consulted but not in control. Contested decisions may involve the Court of Protection.
Common Questions About LPAs and End-of-Life Care
Can an LPA attorney make end-of-life care decisions?
Yes. A Health and Welfare attorney can make decisions about palliative care, hospice placement, and care arrangements at the end of life. They can also refuse non-life-sustaining treatment. Decisions about life-sustaining treatment — such as withdrawal of ventilation — require specific authority in the LPA.
Can an attorney decide where someone dies?
Yes. A Health and Welfare attorney can make decisions about care settings, which includes choosing whether someone receives care at home, in a hospice, or in hospital. The attorney should try to reflect the donor’s known wishes about where they wanted to be.
How does an LPA interact with an Advance Decision at end of life?
An Advance Decision to Refuse Treatment can refuse specific treatments in defined circumstances and is legally binding if valid. A Health and Welfare LPA with life-sustaining treatment authority gives the attorney broader discretion. If both exist, the more recently created document generally takes precedence for the same decision. Having both is recommended.
What if an attorney disagrees with the palliative care team?
The attorney has authority to make welfare decisions but must act in the donor’s best interests. Clinicians can involve an Independent Mental Capacity Advocate or apply to the Court of Protection if they believe the attorney is not acting appropriately. Most disagreements are resolved through open discussion.
This guide was last reviewed and updated on . Information is based on current legislation and OPG guidance for England and Wales.
Official Guidance
Relevant government resources
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