Lasting Power of Attorney vs. Advance Directive: What’s the Difference and Which Do You Need?

When planning ahead for your future health and care, two of the most important legal tools available are the Lasting Power of Attorney (LPA) for Health and Welfare and the Advance Directive (also known as an Advance Decision or Living Will). While they both allow you to plan for medical decisions if you lose capacity, they serve different roles—and understanding the difference is essential for making informed choices.

In this article, we explain how these two documents work, their key differences, and the benefits of having one—or both.

What Is a Lasting Power of Attorney for Health and Welfare?

A Health and Welfare LPA is a legal document that allows you to appoint one or more people (attorneys) to make decisions on your behalf if you lose the mental capacity to do so yourself. These decisions can include:

• Where you live and who cares for you

• What you eat and how you're looked after

• Whether or not you receive medical treatment

• Decisions about life-sustaining treatment (if you choose to give your attorneys this power)

Key Feature:

You must explicitly state whether your attorneys can or cannot make decisions about life-sustaining treatment.

What Is an Advance Directive?

An Advance Directive, also called an Advance Decision to Refuse Treatment, is a legally binding document in which you directly state which medical treatments you refuse—including life-sustaining treatments—should you lose capacity in the future.

This document only covers refusals of treatment, not positive requests, and it must meet specific legal requirements to be valid.

Key Differences Between an LPA and an Advance Directive

Feature	LPA – Health and Welfare	Advance Directive (Decision)
Who makes the decision?	Attorneys you appoint	You, in advance
Can refuse treatment?	Yes, via attorney or written instructions	Yes – direct refusal
Covers life-sustaining treatment?	Only if you explicitly authorise it	Yes – must be clearly stated
Legally binding on doctors?	Yes, if valid and attorneys act in your best interests	Yes, if valid and applicable
Takes effect when?	When you lose mental capacity	When you lose mental capacity
Can include treatment preferences?	Yes – both binding and non-binding	No – only refusals of treatment

Benefits of a Health and Welfare LPA

1. Appoint someone you trust to make wide-ranging decisions in your best interests

2. Covers more than medical care – also decisions about your day-to-day life and wellbeing

3. Offers flexibility, as attorneys can weigh up circumstances at the time

4. Can include instructions (binding) and preferences (guidance) to shape their decisions

5. Allows attorneys to make or refuse life-sustaining treatment, if you permit this

Benefits of an Advance Directive

1. Directly refuse specific treatments without needing attorneys to act

2. Legally binding on doctors and care teams, as long as it is valid and applicable

3. Takes immediate effect when you lose capacity – helpful in emergencies

4. Reduces the emotional burden on family and attorneys by stating your clear wishes

5. Familiar format for healthcare professionals, often accepted quickly in urgent care

Do You Need Both?

In many cases, yes. Having both documents gives you maximum control.

• Use an Advance Directive to refuse specific treatments (e.g., CPR, ventilation, tube feeding) in clearly defined circumstances.

• Use an LPA to empower trusted individuals to make all other care decisions, including those not covered by the Advance Directive.

Important: If both documents exist and conflict, the one that is more recent generally takes precedence.

What Can You Include in a Health and Welfare LPA?

In your LPA, you can include:

Preferences (non-binding guidance):

“If I have advanced dementia and no longer recognise my loved ones, I would prefer not to be admitted to hospital or receive life-sustaining treatment.”

Instructions (legally binding):

“My attorneys must not consent to resuscitation if I am in the final stages of a terminal illness and unconscious.”

You can tailor your LPA with clear instructions to reflect your wishes about:

• Severe brain injury

• Advanced dementia

• Terminal illness

• Specific treatments you wish to refuse (e.g., ventilation, feeding tubes)

Final Thoughts

Planning ahead can give you peace of mind—and protect your loved ones from having to make difficult decisions without guidance. By combining the flexibility of an LPA for Health and Welfare with the clarity of an Advance Directive, you create a strong legal foundation that ensures your values and choices are respected.

If you’re unsure how to begin or want to make sure your documents are legally sound and aligned, it’s a good idea to seek professional guidance.

Need help preparing an LPA or Advance Directive? Get in touch today—we can walk you through the process and help you put your wishes into writing with clarity and confidence.