LPAs and Medical Treatment Decisions
How a Health and Welfare LPA gives your attorney the power to make medical decisions on your behalf.
Written by Anthony Dalton · Reviewed by James Tyrrell · Last reviewed
If you were unconscious in hospital, who would decide whether you should have surgery? Without a Health and Welfare LPA, that decision falls entirely to your medical team — not your family. An LPA gives your chosen attorney the legal authority to make medical decisions on your behalf if you lose the mental capacity to make them yourself. This guide explains what those decisions can include, how the process works in practice, and the important legal safeguards that exist.
At a glance
- A Health and Welfare LPA gives your attorney legal authority to consent to or refuse medical treatment when you lack capacity
- Authority over life-sustaining treatment must be specifically granted when creating the LPA
- Doctors can still treat in emergencies without waiting for attorney consent
- Without an LPA, your family has no legal right to make medical decisions for you — doctors decide alone
What Medical Decisions Can an Attorney Make?
An attorney with a Health and Welfare LPA can make a wide range of medical decisions on the donor's behalf, but only when the donor lacks the mental capacity to make the specific decision in question. This is a crucial distinction — unlike a Property and Financial Affairs LPA, a Health and Welfare LPA can only be used when the donor has lost capacity.
The types of medical decisions an attorney can make include:
- Consenting to or refusing medical treatment, surgery, or procedures
- Choosing between different treatment options
- Decisions about medication, including starting or stopping specific drugs
- Where the donor receives treatment (e.g., hospital, hospice, or home)
- Decisions about ongoing care and rehabilitation
- Access to medical records and information
One important distinction: while an attorney can make medical decisions, they cannot force a healthcare professional to provide a treatment that the professional considers clinically inappropriate. The attorney's role is to make decisions about whether to accept or refuse treatments that are offered.
Life-Sustaining Treatment
One of the most significant aspects of a Health and Welfare LPA is the option to give the attorney authority over life-sustaining treatment decisions. When creating the LPA, the donor is asked whether they wish to give their attorney this power. This is known as "Option A" on the LPA form.
Life-sustaining treatment is any treatment that a doctor considers necessary to keep the person alive. This can include:
- Artificial ventilation (breathing machines)
- Cardiopulmonary resuscitation (CPR)
- Artificial nutrition and hydration (feeding tubes)
- Blood transfusions
- Antibiotics for life-threatening infections
If the donor has given their attorney this authority, the attorney can consent to or refuse life-sustaining treatment on the donor's behalf. This is an enormous responsibility, and the attorney must always act in the donor's best interests, taking into account the donor's known wishes, beliefs, and values.
Key point: If the donor has not given their attorney authority over life-sustaining treatment, these decisions will be made by the medical team in the donor's best interests, after consulting with family and the attorney where possible.
Advance Decisions and LPAs
An advance decision (sometimes called a "living will") is a separate legal document in which a person specifies treatments they wish to refuse in the future. It is important to understand how advance decisions and LPAs interact.
If a person has both an advance decision and an LPA, the document created most recently takes priority. So if an advance decision was made before the LPA, the LPA takes precedence — the attorney can override the advance decision if acting in the donor's best interests. Conversely, if the advance decision was made after the LPA, the advance decision takes priority for the specific treatments it covers.
This can create confusion, so reviewing both documents together and ensuring they are consistent is well worth doing. Many people choose to include their wishes about treatment refusals as preferences or instructions within the LPA itself, rather than having a separate advance decision.
An advance decision to refuse life-sustaining treatment must be in writing, signed, witnessed, and include a specific statement that it applies even if life is at risk. If these formalities are not met, it is not legally binding for life-sustaining treatment decisions.
Working With Doctors and Healthcare Teams
When a donor is admitted to hospital or receives medical treatment, the attorney should inform the healthcare team that they hold a Health and Welfare LPA. The attorney should provide a certified copy of the registered LPA to the hospital or medical practice, which will be noted on the patient's records.
Doctors and healthcare professionals are required to involve the attorney in decisions about the donor's care when the donor lacks capacity. This means the medical team should explain the available treatment options, the risks and benefits of each option, and what they recommend. The attorney then makes the decision on the donor's behalf.
In practice, the relationship between the attorney and the medical team should be collaborative. The attorney brings knowledge of the donor's wishes, values, and preferences, while the medical team brings clinical expertise. Together, they work to reach the best decision for the patient.
If there is a disagreement between the attorney and the medical team that cannot be resolved through discussion, the matter may need to be referred to the Court of Protection for a ruling. However, this is rare, and most disagreements can be resolved through open communication and, if necessary, mediation.
Emergency Situations
In an emergency situation where the donor needs immediate medical treatment, healthcare professionals do not need to wait for the attorney's consent before providing treatment. The Mental Capacity Act 2005 allows treatment to be provided in an emergency if it is necessary to save the person's life or prevent a serious deterioration in their condition.
However, once the immediate emergency has been dealt with, the medical team should contact the attorney as soon as possible to discuss ongoing treatment decisions. The attorney should ensure that the hospital has their contact details on file so they can be reached quickly.
If the donor has made a valid advance decision refusing a specific treatment, healthcare professionals must respect that refusal even in an emergency — provided they are aware of the advance decision and it is clearly applicable to the situation.
Why a Health and Welfare LPA Matters for Medical Decisions
Without a Health and Welfare LPA, nobody — not even a spouse or close family member — has the legal right to consent to or refuse medical treatment on behalf of an adult who lacks capacity. In such cases, doctors make treatment decisions in the patient's best interests, consulting with family where possible but ultimately making the final call themselves.
An LPA ensures that someone who knows and understands the donor's wishes has the legal authority to speak for them. This can make a significant difference in situations where the donor's wishes differ from what the medical team might otherwise recommend. For more on the attorney's duty to act in the donor's best interests, see our guide on how attorneys act in the donor's best interests.
If you also need to manage the donor's financial affairs alongside their healthcare, see our guide on how LPAs work with banks for practical steps on registering with financial institutions.
Make sure your LPA is properly drafted so it works when you need it. See how our service works or check our pricing.
Key Takeaways
- LPA only applies when capacity is lost — a Health and Welfare LPA can only be used for medical decisions when the donor lacks capacity for that specific decision
- Life-sustaining treatment requires specific authority — the donor must explicitly grant this power when creating the LPA; without it, doctors decide
- Attorneys cannot force treatment — an attorney can accept or refuse treatments offered, but cannot require clinicians to provide treatment they consider inappropriate
- Emergencies do not require consent — the Mental Capacity Act allows emergency treatment to save life or prevent serious deterioration without waiting for attorney consent
- Advance decisions interact with LPAs — the document created most recently typically takes priority where both cover the same treatment
People Often Ask
Can an LPA attorney refuse life-sustaining treatment on the donor's behalf?
Only if the donor specifically granted this authority when creating the LPA. The LPA form includes a specific option for giving the attorney power over life-sustaining treatment decisions. Without this authority, these decisions are made by the medical team.
Can doctors treat someone in an emergency without the attorney's consent?
Yes. The Mental Capacity Act 2005 allows treatment in an emergency if it is necessary to save the person's life or prevent serious deterioration. Once the emergency has passed, the medical team should contact the attorney as soon as possible to discuss ongoing treatment.
Which takes priority: an advance decision or an LPA?
The document created most recently takes priority. If the LPA was made after the advance decision, the attorney can override the advance decision. If the advance decision was made after the LPA, it takes priority for the specific treatments it covers.
This guide was last reviewed and updated on . Information is based on current legislation and OPG guidance for England and Wales.
Official Guidance
Further reading from GOV.UK
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