A Lasting Power of Attorney (LPA) and an Advance Decision (also known as an ADRT – Advance Decision to Refuse Treatment) are two distinct legal tools used in the UK to address future health and welfare needs. They are both used to express an individual’s preferences when they may not be able to communicate or make decisions on their own. However, these tools differ in several important ways.

An LPA is a legal document that allows you (the ‘donor’) to appoint one or more individuals (known as ‘attorneys’) to make decisions on your behalf if you lose mental capacity. There are two types of LPA: one for ‘property and financial affairs’ and one for ‘health and welfare’. The latter includes giving or refusing consent to particular types of health care, including life-sustaining treatment.

A key feature of LPA is that it enables someone else to act on your behalf. This means that the designated attorney(s) can make decisions based on what they think is best for you, guided by what they know or believe your preferences and values to be.

On the other hand, an Advance Decision or ADRT is a written statement that documents your wishes to refuse specific types of medical treatment in certain situations should you lose the ability to make or express decisions in the future. It differs from an LPA in that it does not designate another individual to make decisions for you; rather, it establishes your decisions in advance.

The key difference hence is that an LPA assigns a person to make decisions on your behalf in the event of incapacity, while an ADRT provides direct guidance on specific medical treatments that you would refuse in certain circumstances.

Consider someone who has a debilitating progressive disease, such as multiple sclerosis. They may make an LPA appointing their spouse to make decisions about their health and welfare when they can no longer do so. They could also make an ADRT specifying that they do not want to be kept alive by artificial ventilation should the disease advance to a point where they can’t breathe unaided.

In summary, both LPAs and ADRTs are crucial tools in planning for future incapacity. However, they serve different functions: an LPA delegates decision-making powers to another person, while an ADRT allows you to refuse certain treatments in advance.

Following on from the explanation of the difference between a Lasting Power of Attorney (LPA) and an Advance Decision to Refuse Treatment (ADRT), you may now be wondering about the relationships, interactions, and order of operations between the two.

1. Can I have both an LPA and an ADRT?
   Yes, you can. They serve different purposes – an LPA enables you to nominate someone (your Attorney) to make decisions about your health and welfare or property and financial affairs if you lose the ability to do so, whereas an ADRT outlines your wishes to refuse specific treatments in the future if you lack the capacity to consent or refuse.
2. If I have both, which takes precedence?
   If an LPA was created after an ADRT and gives the attorney the power to consent or refuse the specific treatment in the ADRT, the LPA takes precedence. However, if the ADRT was made after the LPA and is clearly applicable to the current circumstances and treatment, then the ADRT will prevail.
3. How does my healthcare team use information from both the LPA and ADRT?
   The healthcare team uses these documents to understand your wishes and preferences regarding medical treatments and care, especially at the end of your life. They will use the ADRT to understand the specific treatments that you wish to refuse under certain conditions, and the LPA to consult your attorney in making broader healthcare decisions.
4. Can the attorney override my decisions on the ADRT?
   Anything you outlined in the ADRT that you refused, the attorney cannot go back on. However, the attorney can make decisions on treatments you didn’t stipulate in the advance decision.
5. How should I communicate my decisions to my healthcare team?
   For an ADRT to be legally binding, you need to clearly state your decisions in writing and should share the documents with your GP and any other healthcare professionals involved in your care. It’s also important to ensure your attorney is aware of their existence. A service like myADRT (https://myadrt.com/) can make the process more straightforward.
6. Can an LPA or an ADRT be changed?
   Yes, both can be changed as long as you still have mental capacity to do so. If there are changes in your health condition or personal circumstances you might want to review and potentially modify these documents. Changes to the LPA must be registered with the Office of the Public Guardian in England or Wales. Changes in the ADRT should be dated, signed, and shared with all relevant parties.

By understanding how these documents interact, you can make efficient use of both the LPA and ADRT to effectively communicate your wishes regarding your health and care.

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.