Life-Sustaining Treatment Decisions: How to Record Your Wishes in a Health and Welfare LPA

Making decisions about life-sustaining treatment is deeply personal. Whether you would want a ventilator, artificial feeding, or other intensive medical support if you became unable to communicate is a question many people avoid, yet it remains one of the most important choices you can record in advance.

A Health and Welfare Lasting Power of Attorney (LPA) allows you to appoint someone to make health and welfare decisions on your behalf. However, decisions about life-sustaining treatment require explicit authorisation in your LPA document. Without this permission, your attorney cannot make these specific choices, and the Court of Protection may need to become involved.

What Is Life-Sustaining Treatment?

Life-sustaining treatment refers to medical interventions that keep someone alive when their body can no longer function independently. These are not routine medical decisions like taking antibiotics or undergoing surgery.

Common examples include cardiopulmonary resuscitation (CPR), mechanical ventilation to support breathing, artificial nutrition and hydration delivered through feeding tubes, dialysis for kidney failure, and blood transfusions in specific circumstances. These treatments can be life saving in acute situations, but they may also prolong life when recovery is not possible.

The distinction matters because life-sustaining treatment decisions often involve ethical, spiritual, and personal values that extend beyond typical health choices. The law recognises this by requiring separate, explicit consent before your attorney can make these decisions.

Why Life-Sustaining Treatment Requires Special Authorisation

The Mental Capacity Act 2005 treats life-sustaining treatment differently from other health and welfare decisions. Your attorney has broad powers to consent to or refuse routine medical treatment, such as antibiotics, surgery, or physiotherapy. However, the power to make decisions about life-sustaining treatment must be explicitly granted in the LPA document.

This requirement exists because of the profound nature of these decisions. They touch on fundamental questions about quality of life, dignity, religious beliefs, and what constitutes a life worth living. The law places the burden on you to actively confirm that you wish your attorney to hold this power, rather than assuming they will have it automatically.

Without this explicit authorisation, your attorney cannot legally make life-sustaining treatment decisions, even if they understand your wishes clearly. The Court of Protection must then step in, which is costly, time consuming, and removes decision making from those closest to you.

What Is Recording Your Wishes: The Legal Requirements?

When you create a Health and Welfare LPA, the form itself contains a specific section about life-sustaining treatment. You must tick the box that states you are giving your attorney the power to make decisions about life-sustaining treatment. This cannot be done by implication or assumption. It must be deliberate and documented.

The box you tick has important legal wording. It confirms that you authorise your attorney to give or refuse consent to life-sustaining treatment, even if doing so may result in your death. This language is stark but necessary, as it ensures you fully understand the scope of power you are granting.

Some people choose to add additional instructions and preferences alongside this authorisation. For example, you might state that you wish to receive life-sustaining treatment only in specific circumstances, such as if recovery is likely within a certain timeframe. You might specify that you do not wish for CPR but would accept artificial nutrition. These preferences help guide your attorney and medical teams.

What Is Creating Detailed Instructions Beyond the LPA Form?

Ticking the life-sustaining treatment box is only the beginning. Many people benefit from writing detailed instructions that explain their values, beliefs, and specific wishes about different types of treatment. This document complements your LPA rather than replacing it.

Consider addressing these areas: your general philosophy about end of life care, whether you value quantity of life or quality of life more highly, specific circumstances in which you would or would not want particular treatments, the importance of pain relief and comfort, your religious or cultural beliefs that might influence decisions, and any previous experiences that have shaped your views.

Store these instructions with your LPA and ensure your attorney has a copy. Clear instructions and preferences help your attorney understand the reasoning behind your wishes, not just the bare decisions themselves.

What Is Advance Decisions Versus Life-Sustaining Treatment Powers in an LPA?

People often confuse two separate tools: an Advance Decision to Refuse Treatment (also called a living will) and the life-sustaining treatment power in an LPA. Both allow you to express your healthcare wishes, but they work differently.

An Advance Decision is a statement refusing specific medical treatments. It comes into effect if you lose capacity and face that treatment. For example, you might refuse blood transfusions or resuscitation. An Advance Decision binds medical teams and attorneys if it is valid and applies to the situation.

The life-sustaining treatment power in an LPA is different. It gives your attorney the authority to make decisions about life-sustaining treatment on your behalf, including decisions you have not anticipated in advance. Your attorney must apply the Mental Capacity Act best interests test, considering your known wishes, beliefs, values, and any other factors relevant to your welfare.

You can have both an Advance Decision and a life-sustaining treatment power in your LPA. Your Advance Decision takes precedence for the specific treatments you have refused. Your LPA attorney then holds the power to make other decisions within the framework of your values.

What Is the Best Interests Test and Your Attorney’s Role?

When your attorney makes a life-sustaining treatment decision, they must follow the Mental Capacity Act best interests test. This is not about what they would choose for themselves, but what is in your best interests given your circumstances and values.

The best interests test requires your attorney to consider your previously expressed wishes, your beliefs and values, your feelings about your medical condition, the likelihood of recovery, whether the treatment is painful or burdensome, and your overall quality of life. They must consult with family members, carers, and medical teams where practicable.

Medical professionals also apply this test when working with your attorney. If there is disagreement between your attorney and medical teams about what is in your best interests, they will work together to reach a consensus where possible. If disagreement cannot be resolved, either party can apply to the Court of Protection for a decision.

When Your Attorney Can and Cannot Refuse Treatment on Your Behalf

Your attorney’s power to refuse medical treatment depends on whether the treatment is life-sustaining. For treatment that is not life-sustaining, your attorney can refuse it on your behalf if they reasonably believe doing so is in your best interests. This might include declining a particular medication, refusing a non-essential procedure, or opting out of a treatment plan that carries significant side effects without proportionate benefit.

For life-sustaining treatment, the rules are different. Your attorney can only refuse life-sustaining treatment if you specifically granted that power when creating the LPA by ticking the relevant option on the form. Even with that authority, the attorney must still act in your best interests and consider any wishes, values, or beliefs you expressed while you had capacity.

How Medical Teams Respond When an Attorney Refuses Treatment

When an attorney refuses treatment, the medical team is not obliged to simply accept the decision without question. Clinicians have a professional duty to satisfy themselves that the attorney has the legal authority to make that specific decision, that the attorney is acting in the donor’s best interests, and that the decision falls within the scope of the LPA.

If the medical team believes the attorney’s decision is not in the patient’s best interests, they can challenge it. In practice this usually begins with a conversation to understand the attorney’s reasoning. If the disagreement cannot be resolved, the matter can be referred to the Court of Protection for a ruling. In urgent, life-threatening situations, clinicians can provide treatment necessary to prevent death while the legal position is clarified.

What Is The Attorney’s Legal Responsibilities When Making Treatment Decisions?

An attorney making medical treatment decisions carries significant legal responsibility. They must follow the principles of the Mental Capacity Act 2005, have regard to the donor’s past and present wishes, consult with anyone the donor named as someone to be consulted, and consider all relevant circumstances before reaching a decision. The attorney cannot simply impose their own views about what treatment is appropriate. The decision must be centred on what the donor would have wanted or, where that is unclear, what is objectively in the donor’s best interests.

What Is Having the Conversation: Why Discussion Matters?

Granting your attorney the power to make life-sustaining treatment decisions creates a significant responsibility. Before you sign your LPA, discuss your wishes with your chosen attorney in detail.

Do not assume they understand your values simply because they know you well. Talk about specific scenarios: if you had advanced dementia, would you want to be revived if your heart stopped? If you had terminal cancer, would you want artificial nutrition to prolong life? If you suffered a severe stroke, what quality of life would make life worth living for you? These conversations are difficult but essential.

Your attorney needs to understand not just your decisions, but the reasoning behind them. Choosing the right attorney for your LPA means selecting someone who is willing to bear this responsibility and who understands your values deeply enough to act on them under pressure.

What Happens If You Do Not Grant This Power

If your Lasting Power of Attorney does not include the life-sustaining treatment power, your attorney cannot legally make these decisions. If you lose capacity and face a life-sustaining treatment decision, medical teams will attempt to work with your family to reach consensus on what is in your best interests.

However, if there is no agreement or no family member available, or if the situation is particularly complex, an application must be made to the Court of Protection. The Court of Protection can make a declaration about life-sustaining treatment decisions. The process is formal, expensive, and can take weeks or months.

Granting the power to your attorney avoids this necessity and keeps decision making with someone who knows you and understands your wishes. Your attorney has specific legal duties and responsibilities under the Mental Capacity Act, including the duty to act in your best interests and to respect your previously expressed wishes.

Please note: Lasting Powers of Attorney apply in England and Wales only. Different rules apply in Scotland and Northern Ireland.

Frequently Asked Questions

Can I change my mind about granting life-sustaining treatment powers to my attorney?

Yes. You can create a new LPA that cancels the previous one, or you can formally revoke the life-sustaining treatment element while keeping other attorney powers intact. You must have capacity to make this decision. If you have already lost capacity, you cannot change the LPA, though you can create an Advance Decision to refuse specific treatments while you still have capacity.

Does granting this power mean my attorney will force unwanted treatment on me?

No. Your attorney must follow the best interests test and respect your wishes and values. Granting the power does not mean automatic treatment. Your attorney can refuse life-sustaining treatment if that aligns with your wishes and best interests.

What if my attorney and medical teams disagree about life-sustaining treatment?

They will work together to reach consensus based on the best interests test. If disagreement persists, either party can apply to the Court of Protection for a binding decision. You can also include instructions in your LPA about how you wish disputes to be handled.

Can I have specific instructions about which life-sustaining treatments I do or do not want?

Yes. You can add detailed preferences to your LPA stating that you refuse specific treatments (CPR, mechanical ventilation) or accept them only in certain circumstances. You can also create an Advance Decision refusing particular treatments. Your instructions and preferences guide your attorney within the framework of their legal powers.

What if I do not have capacity to create an LPA right now?

If you lack capacity, you cannot create an LPA. However, family members or others concerned about your welfare can apply to the Court of Protection for a decision about life-sustaining treatment if it becomes necessary. An Advance Decision made before you lost capacity can also guide medical teams.

TL;DR: How to Record Your Wishes in a Health and Welfare Lasting Power of Attorney

Life-sustaining treatment decisions require explicit authorisation in your Health and Welfare LPA. You must actively grant your attorney this power by ticking a specific box on the LPA form. Without this permission, your attorney cannot legally make decisions about CPR, mechanical ventilation, artificial nutrition, dialysis, or other life-sustaining treatments.

• Life-sustaining treatment power must be explicitly authorised in the LPA document with a deliberate tick box.
• Life-sustaining treatment includes CPR, ventilation, artificial feeding, and dialysis, not routine medical care.
• Your attorney must apply the Mental Capacity Act best interests test, considering your wishes, beliefs, and values.
• Discussion with your attorney before signing the LPA helps them understand your values and wishes about specific scenarios.
• Without this power in your LPA, the Court of Protection may need to decide life-sustaining treatment issues, which is costly and time consuming.

More From Elwyn & Mabel

Creating a Lasting Power of Attorney is one of the most important steps in planning for the future. Download the free Lasting Power of Attorney Checklist for a step by step guide to getting your LPA in place, explained in plain language.

For personalised guidance on creating a Lasting Power of Attorney or any aspect of estate planning, book a free consultation with Elwyn & Mabel. The team will answer questions, review individual circumstances, and help put the right plan in place.