If somebody is unable make decisions for themselves because of a mental illness, severe learning disability, advanced dementia, brain injury, stroke etc, then they are said to lack mental capacity.

Anyone aged 18 or older who has the mental ability to make decisions for themselves can arrange for someone else to make these decisions for them in the future. This can be done at any time. This legal authority is called ‘power of attorney’. The person who is given power of attorney is known as the ‘attorney’ and must be over 18 years old.

A Lasting Power of Attorney (LPA) is a legal document that lets you (the ‘donor’) appoint one or more people (known as ‘attorneys’) to help you make decisions or to make decisions on your behalf.

This gives you more control over what happens to you if you have an accident or an illness and can’t make your own decisions (you ‘lack mental capacity’).

There are 2 types of LPA: Health & welfare and Property & financial affairs. You can choose to make one type or both.

Health and welfare lasting power of attorney
This LPA to give an attorney the power to make decisions about things such as:

• your daily routine, for example washing, dressing, eating
• medical care
• moving into a care home
• life-sustaining treatment
• it can only be used when you’re unable to make your own decisions

Property and financial affairs lasting power of attorney
This LPA gives an attorney the power to make decisions about money and property for you:

• managing a bank or building society account
• paying bills
• collecting benefits or a pension
• selling your home
• it can be used as soon as it’s registered, with your permission.

How to make a lasting power of attorney

• choose your attorney (you can have more than one)
• fill in the forms to appoint them as an attorney
• register your LPA with the Office of the Public Guardian (this can take up to 10 weeks)
• it costs £110 to register an LPA, although you may be eligible for a reduction or exemption.
• You can cancel your LPA if you no longer need it or want to make a new one.

For further information and for copies of the relevant forms, please visit Office of the Public Guardian or call 0300 456 0300.

A benefits appointee is someone who acts on a person’s behalf in all social security matters.

It is important that everyone, carers included, makes a will. This is even more important if the person you care for has a learning disability or lacks capacity in other ways. By writing a will and setting up a trust, you can make sure that a family member or friend with a learning disability, etc will get the financial support and protection they need after your death.

If you set up a discretionary trust with a solicitor it will become active when the last remaining parent dies. It can encompass not only your son or daughter with a learning disability, but their other siblings too if you wish. You will have to appoint trustees while you are still alive to administer the trust when you are deceased. It is best to choose people who are a generation younger than you, so that they will be around for a long time to support your relative.

Contact Carers Bucks who can signpost you to solicitors who can help with wills and have experience of setting up trusts.

If you care for someone with  a learning disability Mencap run a Planning for The Future service to signpost people, and have useful information they can send you. They also run seminars about wills and trusts around the country throughout the year. They can advise you on where these are in your area.

It is also possible for someone with a learning disability to make a will, if they have capacity to do so. It is best to get specialist legal advice to set one up.

What is an advance decision?

An advance decision to refuse treatment lets your healthcare team know your wishes if you are not able to communicate them. An advance decision is also sometimes known as an advance decision to refuse treatment, an ADRT, or a living will. It is a decision you can make now to refuse a specific type of treatment at some time in the future.

It lets your family, carers and health professionals know your wishes about refusing treatment if you’re unable to make or communicate those decisions yourself. You may want to refuse a treatment in some situations, but not others. If this is the case, you need to be clear about all the circumstances in which you want to refuse this treatment.

If you decide to refuse life-sustaining treatment in the future, your advance decision needs to be written down, signed by you and signed by a witness.

If you wish to refuse life-sustaining treatments in circumstances where you might die as a result, you need to state this clearly in your advance decision. Life-sustaining treatment is sometimes called life-saving treatment. You may find it helpful to talk to a doctor or nurse about the kinds of treatments you might be offered in the future, and what it might mean if you choose not to have them. 

An advance decision is legally binding as long as it complies with the Mental Capacity Act, is valid and applies to the situation.

If your advance decision is binding, it takes precedence over decisions made in your best interest by other people.  Make sure you communicate your wishes to your family, GP and healthcare team when your Decision is finalised and in place.

You can find more information about Living Wills on: 

• the NHS website
• the Bucks Healthcare website
• a downloadable ‘My Advance Care Plan’ template

In hospital, around two out of 10 people survive and leave hospital after having CPR. Survival rates are usually lower in other settings. The chances of CPR working for you can be higher or lower than this. For some people, there will be no chance of benefit from CPR. It depends on why your heart and breathing has stopped, any illness or medical problems you have, and your overall health. Your healthcare team can discuss with you the likely chance of CPR working for you.

Even when CPR is successful, a person can develop serious complications, such as fractured ribs, damage to the liver and spleen and brain damage, leading to disability. People who survive after having CPR may need high-intensity medical support afterwards. A small number need prolonged treatment in an intensive care unit (ICU).

Refusing CPR in advance

Everyone has the right to refuse CPR if they wish. You can make it clear to your medical team that you do not want to have CPR if you stop breathing or your heart stops beating. This is known as a do not attempt cardiopulmonary resuscitation (DNACPR) decision, or DNACPR order. Once a DNACPR decision is made, it’s put in your medical records, usually on a form that health professionals will recognise. It’s also helpful to let your family or other carers know about your DNACPR decision so it does not come as a surprise to them if the situation arises.

For more information about DNACPRs, please visit the NHS website.