Client guide · Health and Welfare LPA
Preparing for Your Health and Welfare LPA Appointment
A practical guide to thinking about who you trust, how you would like decisions about your care to be made, and the things that matter to you personally.
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Your appointment is an opportunity to think carefully about who you would trust to make health and welfare decisions for you if there ever came a time when you could not make a particular decision yourself.
A Health and Welfare Lasting Power of Attorney allows you to choose trusted people, known as attorneys, who may make decisions about your health, care and personal welfare.
These decisions can include giving or refusing consent to healthcare, where you live, the care and support you receive, and day-to-day matters such as your diet, clothing and routine.
Unlike a Property and Financial Affairs LPA, your Health and Welfare attorneys can only make a decision for you when you do not have mental capacity to make that particular decision yourself.
You do not need to understand the legal terminology or arrive with every decision already made. The meeting is designed to help you understand the choices available, think about what matters to you and put arrangements in place that reflect your own wishes and circumstances.
People and decision-making
Start with the people you trust
A Health and Welfare LPA may one day place very personal decisions in the hands of the people you appoint. Thinking carefully about who they are and how they should make decisions is therefore an important part of the process.
Begin With the People You Trust
Choosing your attorneys is one of the most important parts of making a Health and Welfare LPA.
Your attorneys may one day be asked to make very personal decisions about your care, treatment or where you live. It is therefore worth thinking carefully about who would understand you, your values and what matters to you.
When considering someone, you may wish to think about:
- How well they know you
- Whether you trust them to act in your best interests
- Whether they understand your values and wishes
- Whether they would be comfortable discussing difficult health or care decisions
- Whether they are likely to listen to medical and care professionals
- Whether they would be able to speak up for you when necessary
- Whether they would work well with any other attorneys you appoint
Your attorney does not have to be a solicitor, doctor or other professional. Many people appoint a spouse or partner, adult child, relative or close friend.
The important question is whether you trust them with the responsibility.
Remember: Your Attorneys Only Act When You Cannot Make the Decision Yourself
A Health and Welfare LPA does not give your attorneys authority to take over decisions while you are able to make them yourself.
Your attorneys can only make a particular Health and Welfare decision when you do not have mental capacity to make that decision at the relevant time.
Mental capacity is decision-specific.
This means that someone may be able to make some decisions for themselves but need help with others, or may temporarily lose capacity and later regain it.
The LPA is therefore intended to provide authority when it is actually needed, rather than transferring control of your health and welfare decisions as soon as the document is registered.
If You Have More Than One Attorney, How Should They Make Decisions?
If you appoint two or more attorneys, you need to decide how they should make decisions.
The main choices are:
- Jointly and severally — attorneys may make decisions together or individually.
- Jointly — all attorneys must agree on every decision.
- Jointly for some decisions and jointly and severally for others — particular decisions must be made together while other decisions may be made separately.
Jointly and severally is generally the most flexible arrangement, but the appropriate choice depends on what you want and the people you are appointing.
You may want to think about:
- Whether your attorneys live near one another
- How easily they communicate
- Whether they are likely to agree
- Whether there are particular decisions you feel should always involve everybody
- What you would want to happen if one attorney could no longer act
The way attorneys are appointed can also affect what happens if one of them dies or becomes unable to continue, so this is an important area to discuss during your appointment.
Would You Like Replacement Attorneys?
You can appoint replacement attorneys who may step in if an original attorney can no longer act.
This can provide additional resilience if your LPA is intended to remain in place for many years.
A replacement might become relevant if an original attorney:
- Dies
- Loses mental capacity
- Formally decides to stop acting
- In certain circumstances, was your spouse or civil partner and that relationship legally ends
A replacement does not simply step in because an attorney is temporarily unavailable.
How replacement attorneys operate also depends on the way your original attorneys have been appointed.
You do not need to arrive knowing exactly how a replacement arrangement should be drafted. It is enough to think about who you might trust as a second choice.
Care, treatment and personal wishes
Think about the decisions that could matter most to you
A Health and Welfare LPA can cover both major medical decisions and the everyday details of your care and wellbeing. You do not need to predict every future situation, but it can help to think about what matters to you.
Who Should Make Decisions About Life-Sustaining Treatment?
A Health and Welfare LPA contains a specific and important choice about life-sustaining treatment.
Option A — you give your attorneys authority to give or refuse consent to life-sustaining treatment on your behalf.
Option B — you do not give your attorneys that authority, so decisions about life-sustaining treatment remain with the doctors responsible for your care.
Life-sustaining treatment means medical treatment, care, surgery or another intervention that is needed to keep someone alive.
Depending on the circumstances, this can include:
- Major surgery
- Cancer treatment
- Organ transplantation
- Artificial nutrition or hydration
- In some circumstances, treatments such as antibiotics
Whether something counts as life-sustaining treatment depends on the circumstances. Even treatment that might usually appear routine could become life-sustaining in a particular situation.
This choice deserves careful thought.
It is not simply a question of whether you would want treatment or not. The decision is about who you trust to make that decision for you if you cannot make it yourself.
If You Give Your Attorneys Authority Over Life-Sustaining Treatment
If you give your attorneys this authority, they would be able to give or refuse consent to life-sustaining treatment on your behalf if you lacked mental capacity to make that decision yourself.
Your attorneys must still act in your best interests.
You may also choose to include preferences or instructions to help them understand what you would want in particular circumstances.
For example, you may have views about:
- Treatment during the final stages of a terminal illness
- Remaining at home where possible
- Pain relief and comfort
- Particular forms of medical treatment
- Religious or ethical beliefs affecting treatment
- Situations in which you would or would not wish treatment to continue
You do not have to put detailed treatment wishes into the LPA.
For many people, having open conversations with their attorneys about their values and wishes may be just as important.
Think About What Matters to You in Everyday Life
A Health and Welfare LPA is not only about major medical decisions.
Your attorneys may potentially need to make decisions about everyday care and wellbeing.
It may therefore help to think about what makes life comfortable, familiar and meaningful to you.
This could include:
- Where you would prefer to live
- Remaining close to particular relatives or friends
- Staying in your own home for as long as reasonably possible
- Your normal daily routine
- Food and dietary preferences
- Religious or cultural practices
- Exercise and time outdoors
- Hobbies and social activities
- Personal appearance and grooming
- Pets
- People you would like to remain in contact with
- The kind of care environment you would prefer
You do not need to turn all of these things into legally binding instructions.
Often they are simply useful information for the people who may one day need to make decisions on your behalf.
Preferences and Instructions
You can include preferences and instructions in section 7 of your LPA.
You do not have to.
Many people leave this section blank and instead explain their wishes directly to their attorneys.
There is an important difference between preferences and instructions.
Preferences
A preference tells your attorneys something you would like them to take into account.
Your attorneys should consider it, but it does not bind them in the same way as an instruction.
The wording should therefore make clear that it is guidance — for example, using phrases such as “I prefer…” or “I would like…”.
“I prefer to live within five miles of my sister.”
This expresses something important while allowing your attorneys to respond to the circumstances that actually exist at the time.
Instructions
An instruction tells your attorneys something they must or must not do.
Instructions should use clear mandatory language such as “must”, “shall” or “have to”.
“My attorneys must ensure I am given only vegetarian food.”
That is intended to be binding rather than simply something the attorneys should take into account.
Instructions require particular care.
A badly drafted instruction can conflict with another part of the LPA, prevent your attorneys from responding appropriately to circumstances or make part of the LPA unworkable.
You do not need to prepare legal wording before the appointment.
It is far more useful to tell us what matters to you and what you are trying to achieve. We can then consider whether anything needs to appear in the LPA and, if so, whether it should be a preference or an instruction.
Existing wishes and preparation
Tell us about anything already in place
Existing treatment wishes, advance decisions or care plans can be important when preparing a Health and Welfare LPA. You do not need to work out for yourself how they interact — simply let us know that they exist.
Do You Already Have an Advance Decision or Other Written Care Wishes?
Please tell us if you have already made an advance decision to refuse treatment, sometimes called a living will or advance directive.
An advance decision is different from an LPA. It allows someone to specify particular medical treatments that they would refuse in certain circumstances if they were later unable to make or communicate the decision themselves.
The relationship between an advance decision and a later Health and Welfare LPA can be important.
If you give your attorneys authority over life-sustaining treatment, a later LPA may affect an earlier advance decision in some circumstances.
Please also mention any:
- Advance decision
- Advance statement
- Care plan
- Written treatment preferences
- Existing Health and Welfare LPA
You do not need to decide for yourself how these documents interact. The important thing at the preparation stage is that we know they exist.
Is There Anyone You Would Like to Be Notified?
You can name up to five people to be notified when your LPA is about to be registered.
This is optional.
People to notify provide an additional safeguard. They have an opportunity to raise certain concerns with the Office of the Public Guardian if, for example, they believe that you were put under pressure to make the LPA or that fraud was involved.
A person to notify cannot also be one of your attorneys or replacement attorneys.
You may therefore want to think about someone who:
- Knows you well
- Is independent of your attorneys
- Would be willing to raise a genuine concern if necessary
You do not have to nominate anyone.
Information That May Be Helpful
Where available, please have the following information to hand:
- Full names of your proposed attorneys
- Their addresses
- Their dates of birth
- The same details for any proposed replacement attorneys
- Names and addresses of anyone you may wish to nominate as a person to notify
- Details of any existing Health and Welfare LPA
- Details of any advance decision or written treatment wishes
- Notes of any particular care, lifestyle, religious or medical wishes you would like to discuss
- Any questions you have about life-sustaining treatment
- Anything else about your health, care or personal circumstances that you think may be relevant
Do not delay your appointment because you do not have every detail available.
Information can usually be confirmed afterwards.
Before your appointment
You Do Not Need to Have Everything Decided
Many people begin the process knowing who they trust but finding some of the other choices more difficult. Health, care and treatment decisions can feel particularly personal.
The meeting is designed to help you:
- Understand what a Health and Welfare LPA can cover
- Choose the people you trust
- Consider how your attorneys should make decisions
- Think about replacement attorneys
- Understand the life-sustaining treatment choice
- Talk through the things that matter to you personally
- Consider whether preferences or instructions are appropriate
- Identify existing advance decisions or care wishes
- Make decisions at a comfortable pace
You do not need to complete the LPA form yourself before the appointment.
You also do not need to try to predict every illness, care arrangement or medical decision that might arise in the future.
The most useful preparation is simply to think about who you trust, what matters to you and what you would want those people to understand about you.
An important distinction
One Important Difference From Your Property and Financial Affairs LPA
A Property and Financial Affairs LPA can, if you choose, allow your attorneys to help you while you still have mental capacity once the LPA has been registered.
A Health and Welfare LPA does not. Your Health and Welfare attorneys can only make a particular decision when you lack mental capacity to make that decision yourself.
Making a Health and Welfare LPA does not mean giving somebody else control over your healthcare or personal life while you remain able to make those decisions yourself.
Questions Before Your Appointment?
If you have any questions before your meeting, or are unsure what information to bring, please feel free to get in touch. There is no need to prepare formal notes or use legal terminology. A simple list of the people you are considering as attorneys, together with any thoughts about your care, treatment, lifestyle or life-sustaining treatment that you would like to discuss, is enough.