Advance decisions, LPAs, deputies, and the Court of Protection

Some people plan for a time when they may lack capacity. Pharmacy teams do not need to be legal specialists, but they should be able to recognise common documents and know when these affect treatment or information-sharing.

Advance statements and advance decisions

An advance statement sets out a person's wishes, values and preferences for future care. It is not legally binding but should inform best interests decisions.

An advance decision to refuse treatment can be legally binding in England and Wales if it is valid and applicable. It applies only to refusing specified treatment, not to requesting treatment, and can be made only by someone aged 18 or over who had capacity when they made it.

If the decision refuses life-sustaining treatment, further formalities apply: it must be written, signed and witnessed, and must state explicitly that it applies even if life is at risk.

Lasting Powers of Attorney and deputies

In England and Wales there are two types of LPA: health and welfare, and property and financial affairs. A health and welfare LPA can authorise medical decisions but only when the person lacks capacity and only within the attorney's lawful authority. A property and financial affairs LPA does not authorise health and welfare decisions.

Older enduring powers of attorney made before 1 October 2007 can still be valid; they cover property and financial affairs only.

If there is no suitable attorney and ongoing decisions are required, the Court of Protection may appoint a deputy. The Court can also resolve disputes and decide other serious capacity matters.

A relative, attorney, or deputy may be important, but they do not automatically override a person who still has capacity for the decision in question.