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Lasting power of Attorney and Living Wills

Lasting power of Attorney and Living Wills. Kelly Gladwish-Harris GP ST3. Lasting Power of Attorney. LPA replaces the old Enduring Power of attorney

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Lasting power of Attorney and Living Wills

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  1. Lasting power of Attorney and Living Wills Kelly Gladwish-Harris GP ST3

  2. 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

  3. LPA • Property and financial affairs LPA • Decisions about selling donor’s 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

  4. 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.

  5. 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

  6. Making the LPA • Download forms and booklets from OPG website • Postal copies from OPG customer services and legal stationers. • 3 parts to form. • Donor’s statement – restrictions, conditions or guidance for attorney’s decisions. • Certificate provider’s statements (if no named person then need 2 of these) • Attorney’s statement – confirm they understand their legal duties should they need to act as attorney.

  7. “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

  8. 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

  9. Advance directives • Must indicate exactly what type of treatment wish to refuse – detail. Can be in layman’s 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

  10. 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

  11. 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.

  12. 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

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

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