The MCA allows people to plan ahead for future loss of mental capacity through the use of Lasting Powers of Attorney (LPAs), Advance Decisions refusing treatment (‘Advance Decisions’) and through taking into account Advance Statements where a person states what treatments they would like to be given in the event that they lose capacity in the future. Advance statements are not binding, but they constitute evidence of the person’s wishes and feelings when capable and as such are among the issues in the best interests checklist to be taken into account by the best interests decision-maker when the person loses capacity (see s4(6)(a) MCA). .
An LPA is a document which nominates one or more people to make best interests decisions on your behalf if you lose mental capacity in the future. LPAs can be made either for property and affairs decisions, or for health and welfare decisions (s9-14 MCA)). If people have not made an LPA and they lose mental capacity, it might be necessary for the Court of Protection to appoint a ‘deputy’ to manage their property and affairs in their best interests (s16-20 MCA). Most health and welfare decisions can be made without a deputy, using the ‘general defence’ (s5 MCA), so deputies for health and welfare are quite rare.
Advance Decisions allow people to refuse particular treatments in particular circumstances at a future point when they might lose capacity (s24-26 MCA). For non-life saving treatment, it is sufficient for the advance refusal of treatment to be made orally – although writing it down and ensuring that your doctor and people close to you have a copy is often sensible. In order to refuse life saving treatment at some point in the future, the advance refusal needs to be written down and signed and witnessed.
More detailed guidance on each of these instruments can be found in the MCA Code of Practice. The government has provided online information about making LPAs. These need to be registered with a public body – the Office of the Public Guardian. The NHS has created some guidance for people wanting to make Advance Decisions, as have the Alzheimer’s Society, Age UK, and Compassion in Dying. If a person has not made an LPA, but decisions need to be made on their behalf which require formal authority (such as accessing their bank account or selling their property), then the government has provided guidance on how to apply to become a deputy.
If you are concerned about the way that an attorney or a deputy is exercising their authority under the LPA, you should refer the matter to the Office of the Public Guardian.