Health and Welfare LPA vs Advance Decision (Living Will): Which Do You Need, or Both?
By Matt Cresswell, Founder of Power of Attorney Online and author of
Everything you ever wanted to know about LPAs (but were afraid to ask)
07th August 2026
The short answer:
A Health and Welfare LPA allows you to choose trusted people to make health and care decisions on your behalf, if you lose mental capacity. An Advance Decision, sometimes called a Living Will, allows you to refuse specific medical treatments in advance. They're not alternatives. They perform different legal functions and often work best together. A Health and Welfare LPA gives someone authority to make decisions in your best interests, while an Advance Decision gives legally binding instructions refusing certain treatments if specific circumstances arise. Many people also choose to write an Advance Statement to record their general wishes and preferences alongside these documents.
When people begin planning for the future, one question comes up surprisingly often: should I make a Health and Welfare LPA or a Living Will? This guide, Health LPA vs Living Will, explains what each document does, how they work together and why many people benefit from having both. Although they are often mentioned together, they serve very different purposes. Understanding those differences now can make life much easier for your family and healthcare professionals if difficult decisions ever need to be made.
Why people confuse these documents
It’s easy to see why so many people assume these documents are interchangeable.
All of them relate to future healthcare. All of them come into effect only if you lose the ability to make decisions for yourself. All of them help doctors and families understand your wishes.
Yet legally, they are very different.
One appoints people. One records decisions. One simply communicates preferences.
If you understand those three ideas, you’re already most of the way there.
The difficulty is that hospitals, care homes and even some healthcare websites often refer to them collectively as “planning ahead”. While that’s true, each document solves a different problem.
Think of it this way. If something unexpected happened tomorrow, who would speak for you? What decisions would they be allowed to make? And are there any treatments you already know you would never want?
Those are three separate questions. Each document answers one of them.
The three documents explained
Although this article focuses on Health and Welfare LPAs and Advance Decisions, it’s helpful to introduce the third document at the beginning because many families don’t discover it until much later.
| Document | What it does | Legally binding? | Appoints someone? |
| Health and Welfare LPA | Gives chosen attorneys authority to make health and care decisions if you lose capacity | Yes | Yes |
| Advance Decision (Living Will) | Refuses specific medical treatments in defined circumstances | Yes, if valid and applicable | No |
| Advance Statement | Explains your wishes, values and preferences for future care | No, but professionals should take it into account | No |
Each plays a different role.
Together, they can provide healthcare professionals with a much clearer understanding of both your legal instructions and your personal wishes.
What a Health and Welfare LPA actually does
A Health and Welfare Lasting Power of Attorney is about people, not treatments.
It allows you to choose one or more attorneys who can make decisions if you can no longer make them yourself. Those decisions might include:
- where you live
- your daily care
- support services
- medical treatment
- moving into residential care
- decisions about life-sustaining treatment if you specifically give that authority
The important point is that your attorneys don’t simply replace you. They step in only if you lack mental capacity to make that particular decision at that particular time.
If you still have capacity, you remain in control. That’s true even if your LPA has already been registered.
This flexible approach reflects one of the key principles of the Mental Capacity Act.
Capacity is decision-specific. Someone may need help managing complex financial matters while still being perfectly capable of deciding what medical treatment they want.
Equally, someone recovering from illness may temporarily lose capacity before later regaining it.
The existence of an LPA doesn’t remove anyone’s independence. It protects it.
92%+
Drafts with errors
Of the LPAs our specialists have reviewed, more than nine in ten contain at least one issue. About one in five has a major issue that would cause an outright OPG rejection. See our full findings →
What an Advance Decision actually does
An Advance Decision works very differently.
Instead of appointing somebody else, it records decisions you’ve already made yourself. Specifically, it allows you to refuse certain medical treatments in the future if particular circumstances arise.
For example, someone might decide they would not want a particular life-sustaining treatment if they were permanently unconscious with no realistic prospect of recovery. The decision is made while they still have mental capacity.
If the legal requirements are met, healthcare professionals must follow that decision later.
Notice what’s missing?
Nobody is appointed. Nobody interprets your wishes. The document itself contains the decision.
That’s why Advance Decisions usually deal with specific treatments rather than wider questions about care.
They are designed to answer one very narrow question.
“If this medical situation occurs, I refuse this treatment.”
Nothing more. Nothing less.
Why one isn’t a replacement for the other
This is probably the biggest misunderstanding we come across. People often ask:
“If I’ve written a Living Will, do I still need a Health and Welfare LPA?”
Usually, yes.
Imagine someone has written an Advance Decision refusing one specific treatment. A few years later they develop dementia.
Their family now needs to make decisions about where they should live, what care package they need, which hospital is most appropriate and whether they should move into residential care.
None of those decisions is covered by the Advance Decision.
Likewise, imagine someone has a Health and Welfare LPA but no Advance Decision. Their attorneys can make decisions in the donor’s best interests, but they don’t have a legally binding document setting out treatments the donor definitely wanted to refuse.
The two documents aren’t competing with one another. They’re filling different gaps.
One appoints trusted decision-makers. The other speaks directly to healthcare professionals about specific treatments.
Why families often benefit from both
When these documents are used together, they create something much more complete.
Your attorneys understand your values because you’ve discussed them over many years. Healthcare professionals understand your legally binding treatment refusals because they’re clearly documented.
Neither document has to do all the work.
That’s often a much more comfortable position for families. Instead of wondering what you might have wanted, they’re supported by decisions you’ve already made and authority you’ve already granted.
That combination removes uncertainty at one of the most stressful times a family can experience.
A Power of Attorney Online insight
One pattern we’ve noticed when speaking to our Power of Attorney Online customers is that many people initially believe a Health and Welfare LPA is only about end-of-life decisions. In reality, most of the conversations we have relate to much more everyday concerns, such as choosing care providers, speaking with doctors, arranging support at home or helping a parent navigate the health and social care system. End-of-life decisions are important, but they represent only a small part of what a Health and Welfare LPA can help with.
A witness can be related – but they can’t be on the form anywhere else.
When you have both documents, which one takes priority?
This is one of the questions families ask most often, and the answer depends on what decision is being made.
A Health and Welfare LPA gives your attorneys the legal authority to make decisions on your behalf if you lose mental capacity. An Advance Decision allows you to refuse specific medical treatments in advance.
Sometimes those two things overlap. When they do, the law has clear rules about which document takes precedence.
The key factor is when each document was created and whether the Health and Welfare LPA gives attorneys authority to make decisions about life-sustaining treatment.
If you made a valid Advance Decision after creating your Health and Welfare LPA, and the Advance Decision covers the treatment in question, the Advance Decision will usually take priority.
If you created a Health and Welfare LPA after making an Advance Decision and gave your attorneys authority to make decisions about life-sustaining treatment, your attorneys may be able to make decisions that override the earlier Advance Decision.
That surprises many people. It’s one of the reasons these documents should never be viewed in isolation. They need to work together. Whenever someone updates one document, it’s sensible to review the others at the same time to make sure they still reflect their wishes.
The life-sustaining treatment decision that deserves more attention
If you’ve completed a Health and Welfare LPA, you’ll probably remember a section asking whether your attorneys should have authority to make decisions about life-sustaining treatment.
It’s a simple choice on the form. Its consequences are significant. You are asked to choose one of two options.
Option A
Your attorneys can’t make decisions about life-sustaining treatment. Doctors will make those decisions in your best interests, taking account of the Mental Capacity Act and anyone who knows you well. Your attorneys may still be consulted, but they won’t have the final legal authority.
Option B
Your attorneys can make decisions about life-sustaining treatment if you lose capacity. That means healthcare professionals must involve them when those decisions arise.
Choosing Option B doesn’t mean your attorneys can simply demand any treatment they want.
Nor can they refuse treatment for reasons unrelated to your best interests. They remain bound by the Mental Capacity Act. Their decisions must always be reasonable, evidence-based and focused on your welfare.
The purpose of Option B is to allow someone who knows you well to help make incredibly difficult decisions if you no longer can.
Why this isn’t simply about end-of-life care
The phrase “life-sustaining treatment” understandably makes many people think only about resuscitation or intensive care.
The reality is often broader. Depending on the circumstances, life-sustaining treatment could include ventilation, artificial nutrition and hydration, or other treatments keeping someone alive during serious illness.
Most people won’t ever encounter these situations. But if they do, families are often grateful that conversations happened long before decisions became urgent.
Choosing attorneys who understand your values is just as important as understanding the legal paperwork itself.
The role of doctors doesn’t disappear
Another common misconception is that a Health and Welfare LPA allows attorneys to overrule clinicians.
It doesn’t. Doctors remain responsible for providing appropriate clinical care.
Attorneys make decisions where the law allows them to, but those decisions sit alongside professional medical judgement.
Think of it as a partnership. Healthcare professionals bring clinical expertise. Attorneys bring knowledge of the person.
Neither replaces the other. The best outcomes usually happen when both work together.
Where an Advance Decision fits
An Advance Decision is much more specific. It isn’t about appointing someone you trust. It’s about recording treatments you wish to refuse if clearly defined circumstances arise.
Because of that, healthcare professionals don’t ask an attorney to interpret the document. Instead, they consider three questions.
Is it valid?
Does it apply to the current situation?
Does it clearly cover the treatment being considered?
If the answer to all three is yes, the Advance Decision is legally binding. That gives healthcare professionals certainty.
It also removes the emotional burden from family members, who don’t have to guess what their loved one would have wanted.
The document many people never hear about
Alongside LPAs and Advance Decisions sits a third planning document that receives far less attention. The Advance Statement.
Unlike an Advance Decision, an Advance Statement isn’t legally binding. Instead, it tells professionals about the person behind the patient.
It might include things such as:
“I’d like classical music played if I’m distressed.”
“I’d prefer vegetarian meals.”
“My faith is important to me.”
“I’d like my daughter involved in discussions whenever possible.”
These aren’t instructions. They’re insights. Under the Mental Capacity Act, anyone making best interests decisions should take these wishes into account where they’re relevant.
That’s why Advance Statements can be incredibly valuable. They help professionals understand not just what treatment someone wanted, but how they wanted to live.
How all three documents work together
One way to think about them is to imagine three different layers.
Your Health and Welfare LPA answers the question:
“Who should make decisions if I can’t?”
Your Advance Decision answers:
“Are there any treatments I definitely want to refuse?”
Your Advance Statement answers:
“What matters to me as a person?”
Each layer supports the others.
Together, they paint a much fuller picture than any single document could achieve alone.
A real-life hospital scenario
Imagine Margaret is 79. She has advanced Parkinson’s disease and develops a serious chest infection. She’s admitted to hospital and becomes confused. The medical team concludes she temporarily lacks capacity to make decisions about her treatment.
Several important decisions now need to be made.
Should antibiotics continue?
Would intensive care be appropriate?
If her condition deteriorates further, should certain life-sustaining treatments be provided?
Margaret has prepared all three documents.
Her Health and Welfare LPA appoints her two daughters as attorneys and gives them authority to make decisions about life-sustaining treatment.
Her Advance Decision states that if she reaches a permanently unconscious state with no realistic prospect of recovery, she refuses artificial ventilation.
Her Advance Statement explains that maintaining dignity, avoiding unnecessary suffering and remaining close to family are extremely important to her.
Notice how each document performs a different role? The hospital doesn’t rely on just one.
The clinicians discuss treatment options with Margaret’s attorneys. The attorneys explain Margaret’s values and help make decisions in her best interests.
If the exact circumstances described in her Advance Decision ever arise, the medical team follows that legally binding refusal.
Meanwhile, her Advance Statement helps everyone understand the person behind the paperwork.
No single document answers every question. Together, they provide clarity. More importantly, they reduce uncertainty for everyone involved.
How much does each document cost?
One of the advantages of planning ahead is that these documents are relatively inexpensive compared with the cost and stress that can arise if they’re missing.
A Health and Welfare Lasting Power of Attorney must be registered with the Office of the Public Guardian before it can be used. There’s a registration fee, although some people qualify for reductions or exemptions depending on their financial circumstances. You can complete the application yourself using the government forms, use an online specialist service such as Power of Attorney Online, or ask a solicitor to prepare it on your behalf.
An Advance Decision doesn’t have to be registered with a government body. There is no official registration fee, although many people choose to seek professional advice if they’re making complex treatment decisions or refusing life-sustaining treatment.
An Advance Statement can usually be written without any formal process. Some people include it as a separate document alongside their LPA, while others discuss it with family members and healthcare professionals and ensure copies are kept with their medical records.
Although the costs differ, the more important consideration is whether the documents accurately reflect your wishes.
The value lies in the conversations they encourage as much as the paperwork itself.
Which document is right for you?
The answer isn’t always “choose one.” Very often, it’s “choose the combination that fits your circumstances.”
The table below provides a simple starting point.
| If you want to… | Health & Welfare LPA | Advance Decision | Advance Statement |
| Choose who makes healthcare decisions | ✓ | ||
| Refuse specific future medical treatments | ✓ | ||
| Record personal wishes and values | ✓ | ||
| Give someone authority to speak with doctors | ✓ | ||
| Explain your preferences for care | ✓ | ✓ | |
| Create legally binding treatment refusals | ✓ | ||
| Help your family understand what matters to you | ✓ | ✓ | ✓ |
Looking at the table, you’ll notice there is quite a bit of overlap. That’s because these documents complement one another rather than compete.
Most people who have spent time thinking about future healthcare find that they naturally want to answer all three questions:
Who would I trust?
What treatments would I refuse?
What would I want people to know about me?
Why conversations matter more than paperwork
It’s tempting to think these documents solve everything. They don’t. What they do is create clarity.
The conversations you have while completing them are often just as valuable. Your attorneys may discover things they never knew. Perhaps you’d always prefer care at home if possible. Maybe maintaining independence matters more to you than extending life at any cost. Perhaps your faith plays an important part in healthcare decisions.
These aren’t things attorneys should have to guess during a medical emergency. By discussing them now, you remove much of the uncertainty later.
Families consistently tell us that simply having those conversations brings reassurance, regardless of whether the documents are ever needed.
The mistake many families make
One pattern appears again and again.
Families assume they’ll “sort something out” if the time ever comes.
Unfortunately, healthcare decisions rarely arrive with much warning.
A fall.
A stroke.
An unexpected illness.
A sudden deterioration.
The people closest to you may suddenly find themselves trying to understand complex medical information while also wondering what you would have wanted. That’s an enormous responsibility. Planning ahead doesn’t eliminate difficult decisions.
It simply means those decisions begin from a place of certainty rather than guesswork.
A Power of Attorney Online insight
One of the most common comments we hear from customers after completing a Health and Welfare LPA isn’t about the paperwork at all.
It’s relief.
Not because they expect to need the document soon, but because they know the people closest to them won’t be left wondering who should speak on their behalf or what decisions they would have wanted.
In many cases, completing the LPA also prompts conversations about Advance Decisions and Advance Statements that families had been meaning to have for years but never quite knew how to begin.
Planning ahead isn’t simply about legal protection. It’s about giving the people you love confidence when they need it most.
A simple decision framework
If you’re unsure where to start, this framework may help.
| Your situation | Recommended approach |
| I simply want someone I trust to make healthcare decisions if I can’t. | Health and Welfare LPA |
| There are treatments I already know I would refuse. | Advance Decision alongside a Health and Welfare LPA |
| I want doctors and family to understand my values and preferences. | Advance Statement, ideally alongside an LPA |
| I want the fullest possible preparation. | Health and Welfare LPA, Advance Decision (where appropriate) and an Advance Statement |
Notice that very few situations point towards having only an Advance Decision. That’s because healthcare involves far more than individual treatment choices. Most decisions concern everyday care, communication with professionals, where someone lives and how their quality of life is maintained.
Those are precisely the areas where a Health and Welfare LPA makes the greatest difference.
Frequently asked questions
Do I need both a Health and Welfare LPA and an Advance Decision?
Not everyone does, but many people benefit from having both. A Health and Welfare LPA appoints trusted people to make decisions if you lose capacity, while an Advance Decision records specific treatments you wish to refuse. They address different aspects of future healthcare planning.
Can my attorneys ignore my Advance Decision?
Not if it’s valid, applicable and takes legal precedence, in the circumstances. Your attorneys and healthcare professionals must follow the law relating to both documents.
Can I change my mind later?
Yes. As long as you still have mental capacity, you can replace or revoke your Health and Welfare LPA before it is used, update an Advance Decision or write a new Advance Statement reflecting your current wishes.
Does my spouse automatically make medical decisions for me?
No. Marriage or civil partnership does not automatically give someone legal authority to make health and welfare decisions if you lose mental capacity. That’s one of the reasons many couples choose to put a Health and Welfare LPA in place.
Should my attorneys know about my Advance Decision?
Absolutely. Your attorneys should know it exists, understand your reasons for making it and know where to find it if it’s ever needed. Copies should also be shared with your GP and any relevant healthcare professionals where appropriate.
Is an Advance Statement legally binding?
No. Unlike an Advance Decision, an Advance Statement is not legally binding. However, healthcare professionals and anyone making best interests decisions should take it into account when considering your wishes, feelings, beliefs and values.
Bringing it all together
A Health and Welfare Lasting Power of Attorney, an Advance Decision and an Advance Statement all help you prepare for a future where you may no longer be able to speak for yourself.
They simply do it in different ways.
Your Health and Welfare LPA chooses who will make decisions.
Your Advance Decision records which treatments you would refuse.
Your Advance Statement explains what matters most to you as a person.
Together, they create a much clearer picture than any one document can provide on its own. For most families, that’s the real value of planning ahead.
Not because it predicts every situation, but because it gives the people around you the confidence to make decisions that reflect your wishes when your voice can’t be heard.
If you’re thinking about putting a Health and Welfare LPA in place, it’s also worth taking a little time to consider whether an Advance Decision or Advance Statement would complement it. Looking at all three together helps ensure your future healthcare wishes are understood, respected and, where appropriate, legally protected.
Another £92 + 8-10 weeks if rejected. £125 today, with our specialist review.
The cheapest LPA is the one that doesn’t need redoing. See the maths →
Written by Matt Cresswell
Matt Cresswell is the Founder of Power of Attorney Online, a service helping people across England and Wales create Lasting Powers of Attorney through guided online support and expert document reviews. He founded the business following his father's diagnosis with dementia, after experiencing first-hand how confusing the LPA process can be for families. Matt's expertise focuses on Lasting Powers of Attorney, planning ahead and helping families prepare for the future before a crisis occurs.
More than just an LPA application
Create your Lasting Power of Attorney with an Expert LPA Review and an included Future Planning Review, helping you protect what matters most.
- Expert LPA Review included
- Future Planning Review included
- Complete in around 15 minutes
- Friendly human support whenever you need it
01483 510515
