Understanding the Four Documents That Could Shape Your Medical Care and Health & Welfare matters, including where you live.
When planning for the future, many people are surprised to discover that there is not just one document dealing with medical treatment.
Instead, there are four different documents, each serving a different purpose:
- Health & Welfare Lasting Power of Attorney (LPA)
- Advance Decision to Refuse Treatment (ADRT), sometimes called a Living Will
- ReSPECT (Recommended Summary Plan for Emergency Care and Treatment)
- DNACPR (Do Not Attempt Cardiopulmonary Resuscitation)
Although these documents overlap in places, they are not interchangeable. Understanding how they work together can help ensure your wishes are respected if you are unable to speak for yourself.
1. Health & Welfare Lasting Power of Attorney
A Health & Welfare Lasting Power of Attorney is a legal document made under the Mental Capacity Act 2005.
It allows you to appoint one or more trusted people—known as attorneys—to make decisions on your behalf if you lose the mental capacity to make those decisions yourself.
Those decisions may include:
- medical treatment
- where you live
- care arrangements
- daily welfare
- social activities
- who you have contact with
If you choose, your attorneys can also be given authority to make decisions about life-sustaining treatment.
Unlike many people realise, a Health & Welfare LPA can contain much more than simply the appointment of attorneys.
It can also include:
- Preferences – guidance explaining your wishes and values.
- Instructions – legally binding conditions or restrictions that define how your attorneys must exercise their authority.
A professionally drafted LPA often makes full use of these provisions, allowing you to leave clear guidance about the sort of care and treatment you would—or would not—wish to receive.
2. Advance Decision to Refuse Treatment (ADRT)
An Advance Decision to Refuse Treatment is sometimes called a Living Will.
Unlike an LPA, it does not appoint anyone to make decisions.
Instead, it allows you to refuse specified medical treatment in advance.
If it is valid, applicable and complies with the legal requirements of the Mental Capacity Act, it is legally binding on healthcare professionals.
For example, an ADRT (advance decision to refuse treatment) may refuse:
- artificial ventilation
- tube feeding in certain circumstances
- CPR
- other specified life-sustaining treatments
For refusals of life-sustaining treatment, additional legal formalities apply, including written wording confirming that the decision is to apply even if life is at risk.
3. ReSPECT
ReSPECT stands for:
Recommended Summary Plan for Emergency Care and Treatment.
It is not a legal document.
Instead, it is a clinical document completed following discussions between the patient and healthcare professionals.
Its purpose is to guide emergency clinicians who may have to make rapid decisions during a medical crisis.
A ReSPECT form may include:
- recommendations about CPR
- preferred place of care
- hospital admission
- intensive care
- treatments likely to be appropriate
- the person’s wishes and priorities
It helps emergency teams understand both the patient’s values and the clinical recommendations that have been agreed.
DNACPR (Do Not Attempt Cardiopulmonary Resuscitation)
A DNACPR decision is much more limited.
It relates only to one specific question:
Should CPR be attempted if the person’s heart or breathing stops?
A DNACPR does not mean that doctors or nurses stop treating the patient.
It does not prevent:
- pain relief
- antibiotics
- oxygen
- nursing care
- food and drink
- other appropriate medical treatment
It deals solely with cardiopulmonary resuscitation.
Comparing the Four Documents
| Document | Legal Status | Main Purpose | Appoints Decision-Makers? |
| Health & Welfare LPA | Legal document FAR wider than the others. | Appoints attorneys and may contain preferences and legally binding instructions | Yes |
| ADRT (advance decision to refuse treatmen) or Living Will | Legally binding if valid and applicable | Refuses specified medical treatment in advance | No |
| ReSPECT | Clinical document | Guides emergency care and treatment | No |
| DNACPR | Clinical decision | Records that CPR should not be attempted | No |
Which Is Most Important?
There is no single answer because they perform different jobs.
An LPA appoints trusted people to make decisions.
An ADRT (advance decision to refuse treatment) allows you to refuse specific treatments yourself.
A ReSPECT form provides guidance for emergency clinicians.
A DNACPR records a clinical decision about CPR.
For many people, these documents complement one another rather than compete.
Can an LPA Replace an ADRT (advance decision to refuse treatment)?
This is one of the most misunderstood areas of estate planning.
A Health & Welfare LPA allows your attorneys to make decisions if you lose capacity and, if you have chosen to give them that authority, those decisions may include life-sustaining treatment and many other welfare areas, including where you live and who you see.
Your LPA may also contain legally binding instructions governing how your attorneys must exercise their powers.
However, the Mental Capacity Act also provides a separate legal mechanism—the Advance Decision to Refuse Treatment—for refusing specified medical treatment in advance.
Where both documents exist, the legal interaction can become complex, particularly if they appear to overlap or conflict.
Professional advice should always be sought where significant treatment decisions are involved.
Can Doctors Ignore an LPA?
Healthcare professionals must take a valid Health & Welfare LPA seriously.
Where attorneys have authority to make the relevant decision, doctors should consult them and recognise the legal authority granted by the LPA.
Likewise, attorneys are bound by any valid instructions contained within the LPA.
However, healthcare professionals also remain subject to their own legal and professional duties. They are not required to provide treatment that is unlawful or clinically inappropriate.
Similarly, attorneys cannot require treatment that clinicians conclude offers no realistic clinical benefit.
The law aims to balance personal autonomy with professional clinical judgment.
Which Documents Should You Have?
There is no single answer suitable for everyone .
For many people, a Health & Welfare LPA is the essential starting point because it appoints trusted people to make decisions if they should become unable to make decisions temporarily or permanently. It is a far cheaper option than the alternative, leaving your life decisions in the hands of the court of Protection.
Some people may also wish to make an Advance Decision to Refuse Treatment if they have strong views about refusing specific medical interventions.
Those with serious illness or advancing frailty may benefit from discussing a ReSPECT plan with their healthcare team.
Where appropriate, clinicians may also recommend a DNACPR decision.
These documents are not alternatives. They address different aspects of future care and, when used appropriately together, can provide both legal certainty and clear clinical guidance.
Final Thoughts
Few of us like to think about losing the ability to make our own medical decisions.
Yet planning ahead can spare our families uncertainty and help ensure that our wishes are understood and respected.
A Health & Welfare Lasting Power of Attorney gives someone you trust the legal authority to speak for you.
An Advance Decision to Refuse Treatment allows you to refuse specified treatments in advance.
A ReSPECT plan helps emergency clinicians understand your wishes and the most appropriate course of treatment.
A DNACPR decision addresses one specific aspect of emergency care—whether cardiopulmonary resuscitation should be attempted.
Together, these documents form an important part of advance care planning. Understanding the role of each one enables you to make informed decisions about your future and gives those caring for you the best possible guidance should the unexpected happen.