Advance Decisions, LPAs, Deputies, and Attorneys

Some patients make arrangements for a time when they may no longer have capacity. These arrangements can affect dental care, particularly for complex, invasive, or sedated treatment or where treatment is contested. Dental nurses should recognise the types of documents and seek verification rather than attempt to interpret legal authority alone.

Key terms

• Advance statement: a record of wishes, beliefs, values, or preferences that can guide care but is not usually legally binding.
• Advance decision to refuse treatment: a legally binding refusal of specified treatment if it is valid and applicable to the situation.
• Health and welfare LPA: a person appointed to make certain health and welfare decisions if the patient lacks capacity.
• Deputy: a person appointed by the Court of Protection to make decisions within the scope set by the court order.

Authority must be checked. A relative, friend, or carer may know the patient well, but that does not automatically give them authority to consent to dental treatment. Even when someone has authority, the patient’s involvement, comfort, and best interests remain central.

In practice a dental nurse may spot mismatches: a family member claims decision-making power but the paperwork covers only finances; the patient is able to answer questions; or the proposed treatment lies outside the authority granted. Such issues should be escalated rather than debated at the chairside.

Checking legal authority

A person who knows the patient well may be very helpful, but legal authority to decide for the patient must be checked, not guessed.