Lasting power of Attorney and Living Wills

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Lasting power of Attorney and Living Wills

• Kelly Gladwish-Harris GP ST3

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Lasting Power of Attorney

• LPA replaces the old Enduring Power of attorney
• Enables person who has capacity and over 18 to
  choose a person(s) to make decisions on their
  behalf at a time in the future when they lack the
  capacity to make their own decisions or no longer
  wish to.
• Can only be used once they are registered with
  the Office of the public guardian.
• www.publicguardian.gov.uk

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LPA

• Property and financial affairs LPA
• Decisions about selling donors house, managing
  their bank account, pay bills, collect benefits
• Can appoint attorney to manage affairs while you
  still have capacity as well as when lack
  capacity.
• Health and Welfare LPA
• Decisions outline can only be taken by the
  attorney when Donor lacks the capacity to make
  them themselves.
• To use it the LPA must be registered and donor
  must lack capacity. Best to be registered in
  advance while person still has capacity

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Health and personal welfare LPA

• Decisions include
• Where to live - at home with support or move to
  residential care
• Day to day personal welfare care diet, dress,
  routine
• Can include giving or refusing consent,
  particularly types of healthcare including
  treatment decisions.
• Life sustaining Rx need to expressly give
  chosen attorney power to make these decisions.
  Option A or B section 5 of the form.

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Making the LPA

• Powerful legal document. Advise care and can get
  solicitor to help although forms designed to be
  simple.
• Persons involved-
• Attorney(s) must agree to take on this role
• Donor
• Named person chosen to be informed when the
  application to register the LPA is made.
  Safeguard
• Certificate provider Selected by donor to
  complete Part B certificate, confirms they
  understand the LPA and are not under pressure.
  e.g. doctor or solicitor
• Witness

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Making the LPA

• Download forms and booklets from OPG website
• Postal copies from OPG customer services and
  legal stationers.
• 3 parts to form.
• Donors statement restrictions, conditions or
  guidance for attorneys decisions.
• Certificate providers statements (if no named
  person then need 2 of these)
• Attorneys statement confirm they understand
  their legal duties should they need to act as
  attorney.

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Living Wills

• Advance directive (advance decision)
• Legally binding. Decision to refuse treatment
• Advance statement
• Covers any other decisions on how they would like
  to be treated.
• Not legally binding but should be taken into
  account when deciding what is in best interests
  of the person

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Advance statement

• General statement of wishes and views
• Preferences, indicate what treatment or care
  wanted should they be unable to communicate their
  wishes in future
• Can include non medical food preferences, bath
  versus shower
• Reflect values and beliefs.
• Can also indicate who they might wish to be
  consulted if they lacked capacity
• Can incorporate a statement as part of LPA

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Advance directives

• Must indicate exactly what type of treatment wish
  to refuse detail. Can be in laymans terms
• An adult with mental capacity can refuse
  treatment for any reason, even if it leads to
  their death.
• Unable to insist on particular medical Rx
• Must be over 18 and have mental capacity to make
  decision
• Understand, weigh up and retain information to
  make decision to refuse Rx, then be able to
  communicate that decision

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Making an advance directive

• Does not have to be in writing unless refers to
  refusal to life sustaining Rx.
• Can be verbal but more risk that it might not be
  carried out unless witnessed and documented by
  someone else.
• Age concern recommendations
• Decision in writing
• Name, DoB, address and GP details
• Statement that advance decision should apply if
  lack they capacity to make the decision at the
  relevant time.
• Specifics what kind of treatment to be refused
  and under what circumstances
• Sign and date
• Witness to signature

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Advance directive refusing life saving treatment.

• Must meet certain requirements of Mental capacity
  Act.
• Life sustaining treatment defined as treatment
  that in the view of the person providing health
  care to the person concerned, is necessary to
  sustain their life. This can include artificial
  nutrition and fluids.
• Must be in writing, signed or can instruct
  someone to sign it in their presence. Witnessed.
• Must include written statement that the advance
  decision is to apply to the specific treatment
  even if their life is at risk.

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Advance decisions caveat

• Make sure relatives, GP, hospital Drs are aware
  it exists.
• Cannot be used to
• Ask for anything illegal e.g. euthanasia or
  assisted suicide
• Demand inappropriate care
• Refuse the offer of food and drink by mouth
• Refuse measures solely designed to maintain
  comfort e.g. appropriate pain relief, warmth,
  shelter
• Refuse basic nursing care essential to keep you
  comfortable e.g. washing, mouth care

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Useful resources

• www.publicguardian.gov.uk
• www.ageconcern.org.uk (15 page fact sheet)
• www.patients-association.org.uk