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ADRT vs LPA — SCE Medical Oncology MCQ

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HardSupportive & Palliative OncologyADRT vs LPASCE Medical Oncology

In 2024 a capacitous woman made a valid ADRT refusing invasive ventilation in defined end-stage motor neurone disease. In 2025 she registered a health-and-welfare LPA that expressly authorised her attorney to decide about the same treatment. She now lacks capacity and meets those circumstances. Which rule applies?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — The later LPA displaces that refusal, so the attorney decides within its authority and the best-interests framework

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as D · D = shown as E

C is correct. A health-and-welfare LPA can authorise treatment decisions only after the donor loses capacity. When it is made later and expressly gives the attorney authority over the same treatment, the earlier ADRT is no longer controlling for that treatment; the attorney must act within the instrument and in the donor’s best interests. A states the priority backwards. B makes court involvement automatic rather than a route for unresolved dispute. D cannot be resolved by clinician preference. E confuses consultation with legal decision-making authority. The documents, their dates, registration and precise scope must be verified before action.

Reference: NHS advance decision to refuse treatment guidance: https://www.nhs.uk/tests-and-treatments/end-of-life-care/planning-ahead/advance-decision-to-refuse-treatment/; NHS lasting power of attorney guidance: https://www.nhs.uk/social-care-and-support/making-decisions-for-someone-else/giving-someone-power-of-attorney/