An LPA, or Lasting Powers of Attorney, is a legal document that allows someone (the donor) to appoint one or more people (known as ‘attorneys’) to make decisions on their behalf in case they lose capacity to do so. There are two types of LPA: one for property and financial affairs, and one for health and welfare.

An Advance Decision to Refuse Treatment (ADRT), also known as a Living Will, is a decision you can make now to refuse a specific type of treatment at some time in the future. It lets your family, carers, and medical professionals know your wishes about refusing treatment if you’re unable to make or communicate those decisions yourself.

Although both LPAs and ADRTs relate to decisions made in the future, they do not typically “override” each other as their roles are distinctly defined. However, the timing of when these documents were made and what they contain can impact which one takes precedence.

An ADRT is considered legally binding if it is valid and applicable – meaning if it clearly states the refusal of a specific treatment, in known circumstances, and you had capacity when you made it. However, if you later establish an LPA for health and welfare after creating an ADRT, and you give your attorney(s) the authority to make decisions about the same treatment you outlined in your ADRT, then the LPA takes precedence over the ADRT. This is because it is the later decision.

For example, let’s say you make an ADRT refusing kidney dialysis in certain circumstances. A few years later, you create an LPA for health and welfare and grant your attorney authority to make decisions about kidney dialysis. The LPA is honoured as the valid document because it was created more recently.

In contrast, if you execute an LPA first and then later create an ADRT, the ADRT would take precedence, assuming it is valid and applicable to the situation.

Given the complexities involved, it’s crucial to ensure that anyone you’ve appointed as a health and welfare attorney is aware of your ADRT and understands your wishes. It’s also highly recommended to seek legal advice in these matters to ensure that your preferences and rights are appropriately safeguarded.

Pre-emptive Question 1: What happens if I create both an LPA and an Advance Decision?

An Advance Decision (to Refuse Treatment), or ADRT, is a legally binding document in the UK that allows individuals to refuse specific medical treatment in the event they lose the capacity to make these decisions in the future. A Lasting Power of Attorney (LPA) for Health and Welfare, on the other hand, involves appointing a trusted person to make these types of decisions on your behalf if you lose capacity.

If you have both an LPA and an ADRT, the issue of which takes precedence depends primarily on timing. If the ADRT is made after the LPA is registered, the ADRT will take precedence over the appointed attorney’s decision-making power about the specified treatment. Conversely, if the LPA is registered after making an ADRT, the LPA would have authority, assuming that the LPA specifically gives the attorney power to give or refuse consent to the exact treatment.

For example, if you made an ADRT to refuse life-sustaining treatment in 2016 and then made and registered an LPA for Health and Welfare in 2018, without cancelling the ADRT, then your attorney would be expected to respect your earlier decision, as specified in the ADRT. However, if the LPA was given specific authority over that decision in the LPA document, the attorney could potentially override the ADRT.

Pre-emptive Question 2: How can I ensure that my preferences are honoured?

Communication with your attorney and healthcare professionals is key. It’s essential to discuss your wishes, values, and any specific instructions with your LPA attorney. If you change your mind after creating an ADRT, you should make your attorney and healthcare team aware. Keeping all documents up to date and easy to find will immensely help ensure that your preferences are honoured.

For example, you could create an ADRT via an online service like myADRT (https://myadrt.com/). After registering the document and sharing it with your healthcare team and attorney, any changes to your preferences can be made and documented via the same platform. This centralisation makes it easier for everyone involved to understand and respect your decisions regarding your health.

Pre-emptive Question 3: Can I have more than one LPA?

Yes, it is possible to appoint more than one attorney using an LPA. You should specify whether they need to make decisions jointly (all must agree), or jointly & severally (they can decide separately), depending on what works best for you.

For example, you may have two children and decide to make them both attorneys. You could specify they must act jointly regarding life-sustaining treatments (both must agree on decisions), but can act jointly and severally on all other matters (may decide separately).

If you are considering creating an ADRT or updating an existing one, we encourage you to register your ADRT form with myADRT by visiting https://myadrt.com/register/  By registering with myADRT, you can ensure that your document is created, stored, and shared more efficiently with healthcare professionals and trusted individuals involved in your care.

Additionally, please consider sharing the myADRT service with your friends, family, or loved ones who may also benefit from having an ADRT in place. By spreading the word about this valuable service, you can help others take control of their future medical care and ensure their wishes are respected even when they are unable to communicate them personally. Registering an ADRT with myADRT is a proactive step towards peace of mind for both you and the people who care about you.