Living Will Northern Ireland: Advance Statements and the Health and Welfare Gap

In England and Wales, you can appoint someone to make healthcare decisions for you through a Health and Welfare Lasting Power of Attorney. In Scotland, you can use a Welfare Power of Attorney. In Northern Ireland, you cannot do either. There is no operational statutory mechanism for granting anyone legal authority over your health, care, or welfare decisions.

This gap makes advance statements — sometimes called living wills — the single most important health-planning tool available to families in Northern Ireland.

Why There Is No Health and Welfare EPA

Northern Ireland's Enduring Power of Attorney covers property and financial affairs only. It was created under the 1987 Order, long before health and welfare powers were considered necessary.

The Mental Capacity Act (Northern Ireland) 2016 was supposed to introduce Lasting Powers of Attorney that would cover both financial and health decisions — bringing Northern Ireland in line with the rest of the UK. The Act received Royal Assent, but the Department of Health has never commenced the provisions relating to health and welfare LPAs.

As of 2026, Northern Ireland remains the only jurisdiction in the UK and Ireland without an active statutory framework for appointing a health and welfare attorney. There is no timeline for when — or whether — the provisions will be switched on.

How Healthcare Decisions Are Made Without a Health Attorney

When a parent lacks the mental capacity to make their own healthcare decisions, no family member has the legal right to consent to or refuse treatment on their behalf. Instead:

Clinical best interests: doctors and social workers make decisions under the best interests framework in the Mental Capacity Act (NI) 2016. They must consider the patient's past wishes, beliefs, values, and any written statements — but the clinical team's assessment of what is medically necessary takes precedence if there is a disagreement.

Family consultation: the clinical team must consult close family members and anyone involved in the patient's care. This is a consultation, not a consent process — the family's views are considered but are not binding.

HSC Trust authority: for care placement decisions (which care home, what level of care), the HSC Trust holds ultimate authority for funded placements. Self-funding families have more control over placement choices.

What an Advance Statement Does

An advance statement is a written document in which a person records their wishes, preferences, and values regarding future medical treatment and care. While not legally binding in the same way as an advance directive under English law, an advance statement in Northern Ireland must be taken into account by healthcare professionals making best interests decisions.

An effective advance statement should cover:

• Treatment preferences: what treatments the person would or would not want in specific scenarios (life-sustaining treatment, resuscitation, artificial nutrition)
• Care preferences: preferences about where they want to receive care (home vs care home), daily routines, religious or cultural observances
• The people they trust: who they want consulted about their care, and whose views they want given weight
• Values and beliefs: what matters most to them — independence, comfort, dignity, being near family

Advance Statements vs Advance Decisions

In England and Wales, an "advance decision" to refuse treatment is legally binding if properly drafted. Northern Ireland does not have the same statutory framework for binding advance decisions. However, a clearly written advance statement expressing specific treatment refusals carries significant weight in clinical decision-making — particularly when it is witnessed, dated, and shows the person understood the implications.

The stronger and more specific the document, the more difficult it is for a clinical team to justify overriding it.

Writing an Effective Advance Statement

• Be specific: "I do not want to be resuscitated if I have advanced dementia and no prospect of recovery" is far more useful than "I want a natural death"
• Date and sign it: clinical teams give more weight to recent, clearly signed documents
• Have it witnessed: an independent witness adds credibility
• Give copies to: your GP, any hospital consultants involved in your care, and your closest family members
• Review it periodically: update it if your circumstances, health, or wishes change
• Store it accessibly: a statement that nobody can find when it is needed is useless

Combining an EPA With an Advance Statement

The most comprehensive protection available in Northern Ireland right now combines:

1. An Enduring Power of Attorney for financial and property decisions
2. An Advance Statement recording health and care preferences
3. Naming a trusted person in the advance statement whom doctors should consult first

This combination covers both financial authority (through the EPA) and health preferences (through the advance statement), working within Northern Ireland's current legal framework.

Get Both Tools in One Kit

The Northern Ireland Enduring Power of Attorney & Controllership Kit includes an Advance Statement template alongside the EPA process guide, giving families a complete planning package for both financial and healthcare decisions.

See more Northern Ireland guides →