Lasting Powers of Attorney (LPAs) and religious beliefs

Planning for the future often involves more than simply putting financial arrangements in place. For many people, their religious beliefs and deeply held personal convictions will have a significant impact on their healthcare, medical treatment and eventual end-of-life care wishes.

We sometimes hear from clients that they have concerns over these values being honoured when they’re no longer in a position to dictate their preferences for themselves.

In these cases, a Health and Welfare Lasting Power of Attorney (LPA) can be a valuable tool for ensuring that these wishes are respected should you lose the mental capacity to manage your own affairs.

While an LPA cannot compel doctors or healthcare providers to act unlawfully or provide inappropriate treatment, it can help ensure that your attorneys understand your values and take them into account when making decisions on your behalf.

Health and Welfare LPAs: an overview

A Health and Welfare LPA allows you (the ‘donor’) to appoint one or more trusted individuals (known as ‘attorneys’) to make decisions about your health and personal welfare if you are no longer able to do so yourself.

Decisions covered under this type of arrangement may include:

• Medical treatment and care
• Living arrangements and care home choices
• Daily care and routines
• Dietary requirements
• Decisions about life-sustaining treatment (if expressly authorised)

The Office of the Public Guardian oversees the registration of LPAs and is bound by strict guidance on the preferences and instructions outlined in these documents, which are considered legally binding.

However, it’s important to note that even if you have an LPA in place, attorneys are only permitted to make health and welfare decisions once you lack the mental capacity to make those decisions yourself (and not before).

Discussing your religious preferences early

Many religious beliefs and practices can have significant implications for an individual’s healthcare preferences – for example, some patients may:

• Refuse certain medical treatments on religious grounds
• Follow dietary restrictions that affect care arrangements
• Prefer same-sex carers where possible
• Wish to receive spiritual or religious support during illness
• Have specific requirements concerning blood transfusions, organ donation, resuscitation or end-of-life care
• Wish certain religious rites or practices to be observed at key stages of their care

Without clear guidance, family members and healthcare professionals may be left uncertain about how best to reflect these wishes when making decisions during periods of incapacity.

An LPA provides an opportunity to create a written record what you would like to happen in different scenarios – reducing the risk of misunderstandings or disagreements between loved ones and care givers at what may already be a stressful time.

Selecting the right attorney

Perhaps one of the most important steps in ensuring your values are honoured in this matter will be selecting attorneys who understand and respect your individual beliefs.

While it’s therefore understandable that many people choose spouses, partners or adult children for the role, it’s essential to consider whether your chosen attorney:

• Understands the nuances of your religious beliefs
• Will be comfortable advocating for your wishes
• Can make difficult decisions under pressure
• Is likely to work constructively with healthcare professionals
• Will place your wishes and values at the forefront of any decision-making process

It’s important to have open discussions about your preferences with family members – even when they share your faith and convictions – to help ensure that assumptions are not made.

Preferences vs Instructions

The Health and Welfare LPA form contains dedicated sections that enable you to describe your wishes in detail – these are split into ‘preferences’ and ‘instructions’ categories, which fulfil different but complementary functions.

Preferences

Preferences provide guidance about details or considerations that you would like your attorneys to take into account when making decisions.

For instance, a donor may want their attorneys to take into account their Christian faith when making decisions and encourage spiritual support from the church or community where possible.

Preferences are not legally binding but can provide valuable guidance for attorneys and professionals involved in your care.

Instructions

Instructions are more formal directions that attorneys must follow.

However, it’s critical that any binding instructions be drafted carefully. Overly restrictive or unclear instructions could create practical difficulties down the line or lead to registration problems.

Careful drafting is required here – as words such a ‘I would prefer for…’ versus ‘they must not…’ can make a big difference. The wrong wording can mean the LPA isn’t enforceable or that it’s unworkable in practice.

For this reason, it’s advisable to seek professional legal advice to help ensure that any instructions are valid, workable and consistent with the powers granted under the original LPA.

How to approach different medical treatments

Where particular treatments raise religious concerns, it’s sensible to have detailed discussions with both your attorneys and your legal adviser.

Some faith groups have well-known positions on particular treatments, while individual believers may have their own personal views. Accordingly, it should never be assumed that a person’s preferences align perfectly with wider religious teachings.

If you do have strong beliefs or preferences with regards to different treatments, it’s advisable to discuss the most common procedures – including:

• Blood transfusions
• Artificial nutrition and hydration
• Resuscitation (CPR)
• Ventilation and mechanical life support
• Organ donation and transplantation
• Experimental or emerging treatments
• Pain management and palliative care

As a general rule, following practice guidance for each individual religion, along with OPG guidance on how to distinguish preferences and instructions, ensures the correct wording is used to demonstrate your specific wishes.

Documenting these procedure-specific discussions can also provide useful context if decisions need to be made in the future.

What about life-sustaining treatment?

One of the most significant decisions when creating a Health and Welfare LPA is determining whether your attorneys should have authority to make decisions regarding life-sustaining treatment.

Indeed, the LPA requires you to make a specific choice on this issue as part of the delineation of powers.

If authority is granted, your attorneys may make decisions about accepting or refusing life-sustaining treatment on your behalf when you lack capacity. If authority is not granted, those decisions will generally rest with healthcare professionals acting in accordance with applicable legal principles and your best interests.

For individuals whose religious beliefs strongly influence their views on end-of-life care, this decision warrants particularly careful consideration and discussion before a final choice is made.

Keeping wishes under review

Religious beliefs, personal circumstances and medical advances all influence how people think about healthcare decisions to varying degrees – and these may shift over time.

As such, regularly reviewing your LPA can help ensure it continues to reflect your current wishes. You may particularly find it prudent to revisit your arrangements following:

• Changes in health
• Changes in family circumstance
• Changes in religious practice or beliefs
• The appointment of new attorneys
• Significant developments in medical treatment options

Start the conversation

Every individual’s beliefs, values and life circumstances are unique – which is why a carefully prepared Health and Welfare LPA is so important to providing reassurance that those making decisions on your behalf understand what matters most to you.

By choosing appropriate attorneys, communicating your wishes clearly and obtaining personalised legal advice where necessary, you can take meaningful steps to ensuring that your religious beliefs and treatment preferences remain an important part of any future decision making regarding your healthcare.

Contact us today via 03333 058375, or by email at [email protected], to arrange a confidential discussion with our friendly Wealth Protection team on creating an LPA suited to your individual needs. We’re here to help.