Health and welfare LPA
This LPA only ever comes into force once you cannot decide for yourself. It is also the one that carries the hardest question on the form.
The short answer
- Covers medical treatment, care arrangements, where you live, and day-to-day matters like diet and routine.
- It only takes effect once you lack capacity — unlike the financial LPA, you cannot let attorneys use it while you can still decide.
- You choose separately whether attorneys can give or refuse consent to life-sustaining treatment. This is a specific tick box.
- Without one, doctors and social workers make best-interests decisions and consult your family — but your family does not decide.
- It works alongside, not instead of, an advance decision (living will).
What's on this page
What it covers#
- Consenting to or refusing medical treatment;
- Where you live — staying at home with support, or moving into a care home;
- Day-to-day care: washing, dressing, diet, daily routine;
- Who you have contact with;
- Complaints about your care.
When it takes effect#
Only when you lack the capacity to make the particular decision yourself. Capacity is decision-specific: you might be able to decide what to eat but not whether to have surgery. Attorneys must let you make every decision you still can — they step in for the ones you cannot.
The life-sustaining treatment question#
The form asks you to choose, explicitly, whether your attorneys may consent to or refuse life-sustaining treatment on your behalf — treatment a doctor considers necessary to keep you alive, such as ventilation, resuscitation or artificial nutrition.
- Option A: your attorneys decide, in your best interests, taking into account what they know of your wishes.
- Option B: your attorneys cannot decide; doctors make the decision in your best interests, consulting your attorneys and family.
There is no right answer. What matters is that you choose deliberately, and that you have talked to your attorneys about what you would want — being handed that decision without warning is a heavy thing.
How it differs from a living will#
| Health & welfare LPA | Advance decision (living will) | |
|---|---|---|
| What it does | Appoints people to decide for you | Records a specific refusal of specific treatment |
| Flexibility | High — attorneys respond to circumstances | Low — it says what it says |
| Legally binding | Attorneys decide within the law | Binding on clinicians if valid and applicable |
| Cost | £82 to register | Free to make |
| Covers care and residence | Yes | No — treatment refusals only |
You can have both, but the interaction matters: broadly, whichever was made later takes priority over the earlier one in the area of overlap. If you have an advance decision and then make an LPA covering life-sustaining treatment, say expressly which you intend to prevail.
Choosing attorneys for this one#
Different qualities from the financial LPA. You want someone who:
- knows your values and will actually voice them;
- can hold their own in a room with clinicians;
- is reachable in an emergency;
- will not be so overwhelmed by the decision that they cannot make it.
It does not have to be the same person as your financial attorney, and often should not be.
Talk to your attorneys before you appoint them#
This is the part people skip, and it matters more than the paperwork. Your attorneys may one day be asked what you would have wanted, in a hospital, under pressure, with a doctor waiting. If the first they hear of your views is a form, you have given them a burden rather than a guide.
Worth discussing explicitly:
- How you feel about being resuscitated, ventilated, or fed artificially, and in what circumstances.
- Whether you would want to stay at home as long as possible, even at some risk, or move somewhere safer sooner.
- Anything non-negotiable — religious or dietary requirements, people you would want present, people you would not.
- What "quality of life" means to you in concrete terms, rather than in the abstract.
You can record preferences and instructions in the LPA itself. Preferences are guidance your attorneys should consider; instructions are binding on them. Keep instructions few and clearly worded — an over-restrictive instruction can leave attorneys unable to act at the moment you most needed them to.
What happens without one#
Decisions are made in your best interests under the Mental Capacity Act by the clinicians or social workers responsible for your care. They must consult anyone interested in your welfare, including family — but the decision is theirs, not your family's. If there is a serious dispute, or no one to consult, the Court of Protection or an Independent Mental Capacity Advocate becomes involved.
Many families assume they will "obviously" be asked to decide. They will be asked for their views. That is not the same thing.
Want this checked for your own situation?
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Frequently asked questions
Can my attorney refuse treatment on my behalf?
Only if you chose Option A on the form, giving them authority over life-sustaining treatment. Otherwise they can be consulted but the decision on life-sustaining treatment rests with your doctors, acting in your best interests.
Can I use a health and welfare LPA while I still have capacity?
No. Unlike the property and financial affairs LPA, this one only comes into force once you lack capacity for the decision in question. While you can decide, you decide.
Do I need both types of LPA?
Most people should have both — they cover completely different territory, and the financial one is no help at all in a hospital. If budget forces a choice, most advisers suggest the property and financial affairs LPA first, because its absence causes immediate practical paralysis.
Can my attorney decide to move me into a care home?
Yes, if you lack capacity to make that decision and it is in your best interests. They must consider your past wishes and less restrictive alternatives. If a move would deprive you of your liberty, additional safeguards and authorisation are required.
This is general information, not legal advice. Everyone's situation is different — speak to a qualified adviser before acting. KeepTheLot is an independent information service covering England & Wales. We are not a law firm.
Part of our guide to power of attorney.