Power of Attorney - Help with Instructions re End of Life Decisions Please

SKA123

Newly_retired said:

As a spouse who has been at the bedside of a dying husband, may I add to Silvercar's points?
My late husband was in hospital, dying of heart failure and other causes. He was given assistance with breathing. After about 20 hours we were told that his organs would soon fail as the heart was no longer able to pump blood to them. The breathing device would be turned off and he would die within hours or minutes.  The ward was busy ( three patients died that night ) and we were left with him for several more hours. The doctor returned and said it was time to turn off the device. We agreed ( and he died within minutes. ) Presumably you would not wish your Attorney to agree even then?

You do realise that once your Attorney has died, your wishes will not be fulfilled?

I am not interested in trying to change your beliefs, just to ensure you understand the potential consequences.

Thank you for replying and I am sorry for your loss.
Re the Attorney dying - this is the same for any LPA where there is only one Attorney. The surviving Donor has to find a replacement Attorney and re-register the LPA. Even if you have 2 Attorney's, if one is no longer able to fulfil their duties it would be wise to find a replacement and re-register the LPA.

SKA123

Keep_pedalling said:

The problem I see here is that with only one attorney, this is going to fail for at least one of you. Once your attorney has dies or has lost mental capacity, the LPA fails. For this reason you may as well leave that blank because while you have an attorney who is aligned with your own beliefs then they will do what has been agreed between you but once the LPA fails no one will refer to it so any end of life care decisions will be made by health professionals. 

Thank you. Once an Attorney has died then it is incumbent on the Donor to re-register their LPA with a new Attorney. The same goes for any LPA where the Attorney or Replacement Attorney is no longer able to fulfil the role. 

SKA123

Sea_Shell said:

Keep_pedalling said:

The problem I see here is that with only one attorney, this is going to fail for at least one of you. Once your attorney has dies or has lost mental capacity, the LPA fails. For this reason you may as well leave that blank because while you have an attorney who is aligned with your own beliefs then they will do what has been agreed between you but once the LPA fails no one will refer to it so any end of life care decisions will be made by health professionals. 

I was just going to say similar.

If you are sole attorneys for each other, what happens if either of you lose capacity and/ or die.

Who will then make all those "PoA" decisions that you've documented, if the PoA ceases to be valid at that point?

There will be no one to "fight your corner".

Thank you. Once an Attorney dies or is unable to fulfil the role, then it is incumbent on the Donor to re-register their LPA with a new Attorney. The same goes for any LPA where the Attorney or Replacement Attorney is no longer able to fulfil the role. 

SKA123

silvercar said:

SKA123 said:

silvercar said:

As this seems to be connected to your religious beliefs, do you have a religious leader who could help you with the appropriate words? You can’t be the first in your religion to have this decision.

” For religious reasons, my attorney must not consent to life-sustaining treatment being withdrawn even if for example I am in a persistent vegetative state or terminally in pain”

Consider whether your preference would be not to start a particular life-sustaining treatment to avoid a situation where it had to be withdrawn. I’m thinking of a situation where resources at a hospital were stretched and staff were unwilling to offer you some life sustaining activity if the consequence was they couldn’t remove it eg an artificial breathing device. 

You may also want to have a documented wish, that in the event of any potential dilemma, you would request that advice be taken from a named local religious leader or a certain position within your faith.

Thank you for replying. We don't have personal access to a religious leader because of where we live, however I also contacted some church forums online for their input. Unfortunately many people don't have a PoA in place, hence me reaching out here too as Martin Lewis strongly advocates having PoA's and I had hoped it might be a subject where there was plenty of experience to share.
You raise an interesting point in your final para, whilst there is nobody local or at least within 50 miles, it is definitely worth me following up this line of enquiry, so thank you for suggesting it.
x

I think you are right to do it. I wouldn’t worry that what you are putting in a POA is outside the norm, the whole point of it is to have your views heard when you may not be in a position to state them.

I know the refusal of blood products or the decision not to mechanically aid ongoing life which would result in the need to withdraw it later would be included in a PoA.

Thank you. I have now looked on a variety of faith-led forums and there are some very active debates about the wording which appear to have been prompted by the current Assisted Dying debate in Parliament. So I am hopeful that I will find the right wording that will be succinct, supportive and do-able. 
x

SKA123

sheramber said:

silvercar said:

sheramber said:

If your husband agrees with your wishws  why do you need a POA.

You are sayong he cannot do htings that you have stated he agrees should not be done so  presumably he would not  agree to them.

or, do you not trust him to follow your wishes.

I would say a PoA is needed for exactly this reason, otherwise medical staff can do what they think best or is standard practice rather than listening to the views of the next of kin.

The OP woiuld be better making a 'living will' which is a legal document expressing what she wants. 

If one party dies before the other the living will would still be in force where a POA would not be.

Thank you. I have been looking into a 'living will' in parallel (known as an 'Advance Decision'). My understanding at the moment is that this is so you can make a clear statement in advance if you want to refuse some or all medical treatments such that the refusal means you may/will die vs you may otherwise have recovered. It is legally binding, drawn up by a solicitor, and the medical profession follow what is stated. It is not the same as an LPA as the LPA is where you are specifying who will have the specific authority to make decisions on your behalf and speak for you, whether your incapacity is short or longer term. This is important when decisions can be more nuanced as the Attorney is guided by the LPA Preferences as well as the Instructions and should have a personal relationship with you so they understand your beliefs etc. Personally, I would have both, and the OPG guidelines do state that you can refer to the Advance Decision in the LPA. I don't know whether the Advance Decision is right for us yet though as I am still researching whether it is solely for 'refusal of end of life interventions' or if that is just what it is commonly used for.

elsien

SKA123 said:

Keep_pedalling said:

The problem I see here is that with only one attorney, this is going to fail for at least one of you. Once your attorney has dies or has lost mental capacity, the LPA fails. For this reason you may as well leave that blank because while you have an attorney who is aligned with your own beliefs then they will do what has been agreed between you but once the LPA fails no one will refer to it so any end of life care decisions will be made by health professionals. 

Thank you. Once an Attorney has died then it is incumbent on the Donor to re-register their LPA with a new Attorney. The same goes for any LPA where the Attorney or Replacement Attorney is no longer able to fulfil the role. 

If they still have capacity to do so. at least if you have a replacement attorney in there then it’s less likely that both people will be unable to act.

Going back to the original question, I’m leaving morality out of it, medical professionals can’t be forced to provide a treatment in various circumstances. Which is why DNAR’s are recommendations and not set in stone because even if you have a DNAR saying you want to be resuscitated if resuscitation is futile then the medical professionals are just not going to go there.

And if there is a dispute around best interests and ending life, then even with the power of attorney it will probably end up in court still, and some of the oversights that may happen along the way.

I do think in your circumstances, even with the LPA, you should think about making an advanced statement/living will to back up the LPA in case people do question the decisions that the LPA is making. And if you do, then make sure it’s updated regularly because they can be overturned if they are old documents and there are indications that you may have changed your mind since it was put in place.


Although (and echoing a previous comment), it’s normally the other way around and disputes arising for people who would not want to live receiving treatments, they would probably not choose to have.
putting this in here to give you an idea of how those disputes may be resolved.

 https://openjusticecourtofprotection.org/2025/05/05/determining-the-legal-status-of-a-living-will-personal-reflections-on-a-case-before-poole-j/