Advance Decisions
Overview
An Advance decision can be used to refuse treatment when a patient no longer has capacity. This includes CPR and treatments where refusal may cause the patient’s health to deteriorate or lead to death. Advance decisions cannot demand treatment and relatives or those close to the patient have no legal rights to modify an advance decision.
Advance decisions are valid and legally-binding if:
- They are documented
- They are signed by the patient who is deemed to have capacity
- They are signed by a witness
- They are not influenced or pressured by any outside party e.g. a family member
- The patient has not said or done anything that would contradict the advance decision since making it e.g. the patient saying they’ve changed their mind.
Lasting Power of Attorney
Overview
A Lasting Power of Attorney (LPA) is a legal document that a patient can use to appoint someone to make decisions on their behalf if they lose capacity and are unable to make decisions for themselves.
If an advance decision is made first and then an LPA is made, the LPA overrides the advance decision as it has been made more recently. This only applies if the advance decision gives the LPA the power to deal with the same decision about treatment.
If an LPA is made first, a valid and applicable advance decision stops the LPA from agreeing to treatment as it has been made more recently.
Patients can appoint 1 attorney or more than 1 attorney to act:
- “Jointly” – where they must always make decisions together
- “Jointly and severally” – where they must make some decisions together and some individually
Patients can register an LPA on GOV.UK and this involves fees, or apply for an LPA through a solicitor.
Patients can cancel an LPA at any time provided they have the mental capacity to do so. LPA automatically ends when:
- The LPA or patient dies
- The LPA loses capacity
- The LPA or patient becomes bankrupt (if property and financial affairs LPA)
- If the LPA and patient are married/civil partners and these are annulled
Types
There are two types of LPA:
- Health and welfare LPA
- Property and affairs LPA
Health and welfare LPAs
Health and welfare LPAs can make decisions regarding health. Their powers only come into effect if the patient loses capacity. The LPA can only refuse treatments offered to them, they cannot choose which treatments to have.
Property and affairs LPAs
Property and affairs LPAs can make decisions regarding finances, bills, properties, pensions etc. and their powers can come into effect either immediately or if the patient loses capacity.
