Do You Dunk Biscuits ? Health andWelfare LPA’s: what does attorneyship involve?

26 May 2020

Health & Welfare LPA – being an Attorney is not a simple as you think!                               

Recently, I was asked by a very dear friend to be her Health & Welfare Attorney.  I was honoured to be trusted with such an important responsibility. With my many years of work in medical and health related charities and particularly through my work with TimeFinders, I think she felt that I am probably well placed to understand the real responsibilities of the role.

Although I have known my friend for over 35 years, I suddenly realized how much I would struggle if I was asked about her views on life-sustaining treatment; how much I didn’t know about her likes and dislikes; what made her anxious or comforted; her routines or beliefs and, selfishly, just how much I would worry about making the right decisions about her care and treatment.

There is some anecdotal evidence to suggest that, with the outbreak of Covid-19, there has been a rush of people making applications for both Property & Financial Affairs and Health & Welfare Lasting Powers of Attorney (LPA).  It has made me wonder if the people gladly accepting the role of Attorney for their family members and friends really understand the responsibilities they are taking on.

A quick technical bit: 

  • The person making a LPA and giving the responsibility of Attorneyship is called the Donor.
  • Unlike a Property & Financial Affairs LPA, a Health & Welfare LPA can only be used if it is considered that the Donor does not have the capacity to make a certain decision regarding their treatment or care. This might be because they are unconscious, or it might be because they have dementia or a brain injury etc..
  • The Mental Capacity Act 2005 protects someone’s right to make decisions. Someone may be considered to lack capacity to make a particular decision if:-
    a) they can’t understand the information which is relevant to the decision to
    be made or
  1. b) if they can’t retain the information and therefore
  2. c) can’t use the information as part of the process of making the decision.

At its simplest, as a Health & Welfare Attorney, you can be given responsibility to give or refuse consent to life-sustaining treatment on the Donor’s behalf.  What does that actually mean?  Do you know? Does your Donor know?

When a TimeFinder is preparing to take on the very serious and extensive responsibilities of becoming a client’s Advocate*, part of our work is to very carefully consider with our clients the most commonly used means of giving life-sustaining treatment and the circumstances under which they may be accepted or refused.

Many people will have heard of a DNACPR form (Do not attempt cardiopulmonary Resuscitation of DNR).  With the advent of Covid-19, many will now have thought about artificial ventilation.  How would your Donor want you to act? Would they want you to accept or refuse consent for them to be put into a deep sleep and placed on a Ventilator or for them to receive other non-invasive oxygen therapy? What are their thoughts on heart bypasses and other serious operations, cancer treatments, artificial nutrition and hydration, antibiotics?

Suddenly “at its simplest” isn’t simple at all.

Of course, a Health & Welfare Attorney’s role is not just about making essential decisions about life-sustaining treatments.  In practice, there are also many other decisions to be made long before you might be needed to act at the end of someone’s life.  If the Donor does not have capacity to make decisions about their care, then you will be needed to make choices which protect their best interests and ensures that they receive the best and the most appropriate care.  Care doesn’t just mean having help to get dressed or have a shower, it encompasses all someone’s physical and mental health needs. It also means promoting someone’s mental wellbeing – making sure their unique personality, their life experiences, their likes and dislikes are taken into consideration and that their spiritual needs are also met.

The best care-at-home companies and care homes will want to know as much as possible about the person for whom you are Attorney because the better they know a person and their history, the better the care is tailored to their needs and their well-being promoted. Aside from the obvious questions regarding what sort of care someone would like or dislike and where they would like to be cared for should the need arise, what about the things that make this person special? Their history, their interests, their passions, their joys and their sadnesses?

Trying to think about yourself in this situation can be helpful and enlightening.  Do you like to dunk ginger biscuits in your coffee but never digestives?  Does the idea of dunking at all fill you with disgust?  Are you afraid of spiders or wasps?  What strange quirks do you have that it would be really useful for someone caring for you to know about?

One friend says she has childhood memories  – deeply etched into her brain alongside the smell of lavender furniture polish and a slowly ticking grandfather clock –  of visiting her Great Aunt and kissing a chin full of wiry white whiskers. The idea of being that be-whiskered old lady fills her with horror.  Another friend detests the smell of spearmint. Being in close contact with someone chewing gum makes her feel sick.  Would their Health & Welfare Attorneys know these things?

How would you be comforted if you were living with dementia and were anxious about a seemingly perfect stranger attempting to offer you personal care?  When I was a very small girl my Grandmother used to take one look at my tousled tom-boy – just come down from climbing trees – mop of hair before reaching for her comb and saying “you look like the Wreck of the Hesperus”!   It took me to teenage-hood to understand the reference to Longfellow’s poem but the phrase gives me a very warm and comforting memory of being in my grandmother’s arms having my hair gently un-tousled. I suspect it would give me comfort still if I had dementia and was anxious or afraid.

When I explained my dilemma to my friend, I was overwhelmed by her outpouring of relief. This was something she hadn’t thought about – who ever does? – but the thought that someone would be making sure that the things that are so important to her would be cared about was profoundly comforting.   She and I are now working through many of the questions we ask our clients so I can add to my understanding of my amazing and wonderful friend and make sure, if ever I have to be asked, that I will be making choices on her behalf which we have already discussed and on which I know her decisions.  The reassurance for me is palpable.

* for more information on the TimeFinders’ Advocacy Service
please see https://timefindersuk.com/practical-help-and-emotional-support/advocacy/