Power of Attorney vs Advance Decision (Living Will): What's the Difference?
Power of Attorney vs Advance Decision: Understanding the Difference
When planning for the future, many people come across two documents that sound similar but work very differently: a Lasting Power of Attorney (LPA) and an Advance Decision (sometimes called a Living Will).
Both deal with what happens if you cannot make decisions for yourself. But they take fundamentally different approaches — and understanding the difference could be crucial for you and your family.
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Quick Summary
| Feature | Health & Welfare LPA | Advance Decision (Living Will) |
|---|
| What it does | Appoints someone to make health decisions for you | Records specific treatment decisions in advance |
| Who decides | Your chosen attorney | You — decisions made now, applied later |
| Flexibility | High — attorney can respond to circumstances | Low — only covers situations you anticipated |
| Cost | £74 (myLPA) + £82 OPG registration | Free to create |
| Registration required | Yes, with the OPG | No |
| Can cover life-sustaining treatment | Yes, if you choose | Yes, if specific requirements are met |
| Can be changed | Yes, while you have capacity | Yes, while you have capacity |
What is a Lasting Power of Attorney?
A Health and Welfare LPA lets you appoint one or more trusted people — called attorneys — to make healthcare and welfare decisions on your behalf if you lose mental capacity.
Your attorney can make decisions about:
- Medical treatment
- Where you live
- Daily care and routines
- Social services involvement
- Life-sustaining treatment (if you specifically grant this power)
The Key Advantage of an LPA
The biggest advantage of an LPA is flexibility. Your attorney can respond to the actual situation as it unfolds. Medicine advances, circumstances change, and new options become available. Your attorney can weigh all of these factors and make the best decision for you at that moment.
You can also include preferences and instructions in your LPA to guide your attorney. For example, you might state that you want to remain at home for as long as possible, or that you prefer a particular type of care.
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What is an Advance Decision?
An Advance Decision (sometimes called a Living Will or Advance Directive) is a document where you record specific decisions about medical treatments you want to refuse in the future, if you lose the capacity to make those decisions yourself.
An Advance Decision can cover:
- Refusing specific medical treatments
- Setting conditions under which you would refuse treatment
- Refusing life-sustaining treatment (with specific legal requirements)
Important Limitations
An Advance Decision can only be used to refuse treatment. It cannot:
- Request specific treatments
- Appoint someone to make decisions for you
- Cover non-medical decisions (such as where you live or daily care)
- Force medical professionals to provide treatment they consider inappropriate
Legal Requirements for Refusing Life-Sustaining Treatment
If your Advance Decision includes a refusal of life-sustaining treatment, it must:
- Be in writing
- Be signed by you
- Be witnessed
- Include a clear statement that the decision applies even if your life is at risk
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When Does Each Apply?
Scenarios Where an LPA is Better
Your mother has dementia and needs to move into a care home. An LPA allows her appointed attorney to research care homes, visit them, speak with staff, and choose the best option based on current circumstances. An Advance Decision cannot cover this — it only deals with specific medical treatments.
You have a stroke and need ongoing medical treatment. Your attorney can discuss options with doctors, weigh up the pros and cons of different treatments, and make decisions based on your current medical situation. An Advance Decision could only refuse treatments you had specifically listed in advance — and may not cover the exact situation.
You need someone to manage your daily care. An LPA covers decisions about washing, dressing, eating, and daily routines. An Advance Decision does not cover any of these areas.
Scenarios Where an Advance Decision is Useful
You have strong views about specific treatments. If you know you would never want a particular treatment (such as resuscitation or artificial ventilation), an Advance Decision records this clearly and directly.
You want to refuse treatment in specific circumstances. For example, if you are diagnosed with a terminal illness and the condition has progressed beyond a certain point, you may wish to refuse certain interventions.
You want your wishes recorded regardless of who is making decisions. Even if you have an LPA, an Advance Decision provides an additional layer of clarity about your specific treatment preferences.
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Do You Need Both?
In many cases, yes. An LPA and an Advance Decision work well together:
- Your LPA gives your attorney the legal authority and flexibility to make the wide range of healthcare decisions that may arise
- Your Advance Decision provides clear, specific instructions about treatments you definitely want to refuse
- Your Advance Decision is the rulebook — non-negotiable decisions you have already made
- Your LPA is the captain — your trusted person who can make all the other decisions, guided by your values and preferences
How They Interact
If you have both an LPA and an Advance Decision, the Advance Decision takes priority for the specific treatments it covers. Your attorney must respect any valid Advance Decision. For all other decisions, your attorney has the authority to act on your behalf.
This is actually an ideal arrangement — your most important treatment decisions are locked in, while your attorney has the flexibility to handle everything else.
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Comparison: Creating Each Document
| Process | Health & Welfare LPA | Advance Decision |
| How to create | Online via myLPA or solicitor | Write it yourself or use a template |
| Professional help needed | Recommended | Recommended for complex situations |
| Registration | Must register with the OPG (£82) | No registration required |
| Witnesses required | Yes | Only for life-sustaining treatment refusals |
| Time to create | ~15 minutes with myLPA | Varies — can be quick or complex |
| Time to become active | After OPG registration (weeks) | Immediately |
| Ongoing costs | None after creation | None |
Common Misconceptions
"An Advance Decision is the same as an LPA"
No. An Advance Decision records your own treatment refusals. An LPA appoints someone else to make a wide range of decisions on your behalf."If I have an LPA, I do not need an Advance Decision"
Not necessarily. An LPA gives your attorney decision-making power, but an Advance Decision provides absolute clarity about specific treatments you want to refuse. Having both is the most comprehensive approach."An Advance Decision means doctors will let me die"
An Advance Decision only covers the specific treatments you have refused, in the specific circumstances you have described. Doctors will continue to provide all other appropriate care."My family can make healthcare decisions without an LPA"
No. Without an LPA, your family has no legal authority to make healthcare decisions on your behalf. Doctors will consult your family, but the final decision rests with the medical team.---
Frequently Asked Questions
Is an Advance Decision legally binding?
Yes, if it is valid and applicable to the situation. For refusals of life-sustaining treatment, it must meet specific requirements (written, signed, witnessed, and explicitly stating it applies even if life is at risk).Can I make an Advance Decision and an LPA at the same time?
Yes, and this is actually recommended. They complement each other well.What if my attorney disagrees with my Advance Decision?
A valid Advance Decision overrides the attorney's authority for the specific treatments it covers. Your attorney must respect it.Does an Advance Decision expire?
No, but it can become invalid if you have done something clearly inconsistent with it (such as creating a later LPA that gives your attorney authority over the same treatment decisions without referencing the Advance Decision). Keep both documents up to date.Can I change my mind about an Advance Decision?
Yes, at any time while you have mental capacity. It is a good idea to review it regularly.How much does an Advance Decision cost?
An Advance Decision itself is free to create — you can write it yourself or use a template. There is no registration fee. However, you may want to seek guidance to ensure it is properly drafted.---
The Best Approach: LPA + Advance Decision
For comprehensive protection, consider creating both:
This combination gives you the best of both worlds: flexibility and certainty.
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Start With Your LPA
Creating a Health and Welfare LPA is the most important step you can take to protect your future healthcare decisions. It gives your chosen attorney the legal authority to act on your behalf across a wide range of situations.
At myLPA, you can create your Health and Welfare LPA from just £74 — in about 15 minutes.
Create Your Health & Welfare LPA — £74 →
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Want to Learn More?
Read our complete guide to Health and Welfare LPAs or contact our team if you have questions about how an LPA and Advance Decision work together.
Ready to Create Your LPA?
Don't wait until it's too late. Get both types of Lasting Power of Attorney from just £140 with expert guidance included.
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