Health and Welfare LPAs: Life Sustaining Treatment Decisions

When making a Health and Welfare Lasting Power of Attorney, you must decide whether to give your attorneys authority to make decisions about life sustaining treatment on your behalf. This is one of the most significant choices in the LPA process, and understanding what it means helps you make an informed decision.

What is life sustaining treatment?

Life sustaining treatment refers to any medical treatment that keeps someone alive. Examples include:

• Mechanical ventilation (breathing support)
• Artificial nutrition and hydration (tube feeding)
• Cardiopulmonary resuscitation (CPR)
• Kidney dialysis
• Blood transfusions
• Antibiotics for life-threatening infections

Decisions about these treatments can arise when someone is very ill or nearing the end of life, and cannot express their own wishes.

The choice you must make

When completing a Health and Welfare LPA, you must answer the question: should your attorneys have authority to give or refuse consent to life sustaining treatment on your behalf?

You can answer yes or no. There is no default position - you must make an active choice.

If you give this authority

If you choose to give your attorneys authority over life sustaining treatment, they can:

• Consent to treatment that would keep you alive
• Refuse treatment on your behalf, even if this means you will die
• Work with medical professionals to make end-of-life decisions

Your attorneys must always act in your best interests. They should consider what you would have wanted based on your values, beliefs, and any wishes you expressed while you had capacity.

If you do not give this authority

If you choose not to give your attorneys authority over life sustaining treatment:

• Medical professionals will make these decisions in your best interests
• They will consult your attorneys and family, but the final decision rests with the clinical team
• Your attorneys can still make other health and care decisions

This approach leaves end-of-life treatment decisions with medical experts while still giving your attorneys control over other aspects of your care.

How to decide

This is a deeply personal decision. Consider:

• Trust: Do you trust your attorney to make these difficult decisions according to your wishes?
• Values: Do you have strong views about end-of-life treatment that you want someone to advocate for?
• Communication: Have you discussed your wishes with your potential attorneys?
• Comfort: Would you feel more comfortable with doctors making these decisions?
• Burden: Are you concerned about placing this burden on your attorney?

Discussing your wishes

Whatever you decide, it is helpful to discuss your values and wishes with your attorneys. This might include:

• Your general views on quality of life versus length of life
• Any specific treatments you would or would not want
• Religious or cultural beliefs that should inform decisions
• Any circumstances in which you would want treatment stopped

These conversations ensure your attorneys understand your perspective, even if they ultimately need to make decisions you did not specifically discuss.

Advance decisions

Alongside or instead of giving your attorney this authority, you can make an advance decision (sometimes called a living will). This is a document specifying which treatments you would want to refuse in certain circumstances.

A valid advance decision is legally binding on doctors. It can work alongside an LPA, providing clear instructions for specific situations while your attorney handles other decisions.

The attorney's burden

Consider the emotional weight these decisions carry. Deciding to withdraw treatment from someone you love is extremely difficult. Some people do not give their attorneys this authority because they want to spare them this burden.

Discuss this openly with potential attorneys. They should understand what they may be asked to do and feel able to accept that responsibility.

Guidance from professionals

Many families across Kent, including in Tonbridge and Sevenoaks, find it helpful to discuss these issues with their will writer or solicitor when preparing an LPA. While professionals cannot tell you what to decide, they can help you understand the implications of each choice.

Key takeaways

The decision about life sustaining treatment authority is one of the most important in a Health and Welfare LPA. There is no right or wrong answer - it depends on your values, your relationship with your attorneys, and what would give you peace of mind. Consider your options carefully, discuss them with your attorneys, and seek professional guidance if helpful.