Advance Decision vs LPA: Which Do You Need?

Two documents, one question each

A health and welfare LPA answers: who decides for me? You appoint attorneys, and once you lack capacity they make care and medical decisions on your behalf.

An advance decision (the old name was living will) answers a narrower question: what is my answer to this specific treatment? It is a written refusal of particular treatments in particular circumstances, made now, for a future where you cannot speak. If it is valid and applies to the situation, doctors must follow it. It is legally binding, not a wish list.

So the LPA hands someone the pen. The advance decision pre-writes one page.

Where they overlap, order decides

Both documents can cover life-sustaining treatment, and the law resolves the clash simply: the later document wins.

Make an advance decision, then later sign a health and welfare LPA giving your attorneys authority over life-sustaining treatment (Option A on the form), and the LPA overrides your advance decision. Your attorneys can consent to treatment you had refused on paper.

The other way round, an advance decision signed after the LPA takes priority for the treatments it covers, and your attorneys cannot override it.

Neither document warns you about this. GOV.UK explains it in fragments across several pages. Getting the order wrong, or never checking it, can quietly cancel the exact protection someone thought they had arranged.

Which do you actually need?

If you mainly want the right person in charge, the LPA does the job on its own. Most people trust their attorneys with the life-sustaining treatment call and choose Option A, and that is a complete, coherent setup.

If there are specific treatments you know you would refuse (many people feel strongly about ventilation or resuscitation in the late stages of terminal illness or dementia), an advance decision locks that answer in, so your attorneys never have to make that particular call, and family disagreement cannot reopen it.

If you chose Option B, leaving life-sustaining treatment to doctors, an advance decision pairs especially well: it tells those doctors your answer in advance, and it binds them.

An advance decision needs no registration, no OPG fee, and no solicitor. It needs your signature and one witness, and your GP should get a copy for your medical record.

With PureWill

You can add a personalised advance decision to your LPA order for £24. It arrives matched to the Option A or B choice you made on your LPA, with the signing order spelled out so the two documents reinforce each other instead of cancelling out. New to LPAs? Start with what an LPA is and what it costs.