Advance Directive vs Power of Attorney in Northern Ireland
Families in Northern Ireland routinely assume that setting up a Power of Attorney covers everything — finances, property, and healthcare. It doesn't. And discovering this gap at a hospital bedside, when a parent has already lost capacity, is one of the worst moments this system produces.
Two Separate Domains, Zero Overlap
Northern Ireland uses the Enduring Power of Attorney (EPA) system under the Enduring Powers of Attorney (Northern Ireland) Order 1987. An EPA covers property and financial affairs exclusively. Your attorney can manage your bank accounts, pay your bills, sell your house, and handle your investments. What they absolutely cannot do is make any decision about your medical treatment, personal welfare, or living arrangements.
An Advance Decision to Refuse Treatment (ADRT) covers the healthcare side. It records specific medical treatments you refuse in advance, and it's legally binding on clinicians under common law when valid and applicable. For a life-sustaining treatment refusal, it must be written, signed, witnessed, and include the life-at-risk statement. Unlike an EPA, it doesn't appoint anyone else to decide — it records your own decisions.
| Feature | Enduring Power of Attorney | Advance Decision (ADRT) |
|---|---|---|
| Legal basis | Enduring Powers of Attorney (NI) Order 1987 | Common law |
| Scope | Financial and property matters only | Refusal of specified medical treatments |
| Appoints a proxy | Yes (financial attorney) | No |
| Healthcare authority | None | Legally binding refusal if valid and applicable |
| Registration | Office of Care and Protection (on capacity loss) | No registration — held in GP records |
| Cost | No statutory fee to make; £189 registration fee if later registered, plus any solicitor fees | No statutory cost |
Why NI Is an Outlier
England and Wales solved this problem years ago with the Lasting Power of Attorney, which comes in two flavours: one for finances and one for health and welfare. Scotland has a similar split with Continuing and Welfare Powers of Attorney. In both jurisdictions, you can appoint someone to make medical decisions on your behalf.
Northern Ireland doesn't have this option. The Mental Capacity Act (Northern Ireland) 2016 includes provisions to introduce health-and-welfare LPAs, but those sections remain unimplemented. The Department of Health has been rolling out the Act in phases since 2019, and the welfare LPA provisions haven't reached the front of the queue.
Until they do, an EPA handles your money and an ADRT handles your medical treatment refusals — and nothing bridges the gap between them.
The Dangerous Assumption
The most common mistake is assuming your EPA attorney can step in during a medical crisis. They can't. If you lose capacity and are admitted to hospital, your financial attorney can pay your care home fees, but they have no legal authority to consent to or refuse a medical procedure on your behalf.
In the absence of a valid ADRT, clinicians in Northern Ireland make treatment decisions based on their own "best interests" assessment. They'll consult your next of kin and your EPA attorney for their views, but those views are advisory only. The clinical team makes the final call.
This means a family can be standing at a bedside, united in wanting treatment stopped, and the medical team can proceed anyway if they believe it's in the patient's best interests. Without an ADRT that specifically refuses the treatment in question, there's no legally binding mechanism to override that clinical judgment.
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What You Actually Need
You need both documents. The EPA protects your financial affairs if you lose capacity. The ADRT ensures your healthcare wishes are followed when you can't speak for yourself.
Draft the ADRT while you're well. Include specific treatments you refuse, the clinical circumstances in which each refusal applies, and the life-at-risk clause if you're refusing life-sustaining interventions. Have it witnessed by an independent adult, file a copy with your GP surgery, and tell your EPA attorney where the original is stored.
Our Northern Ireland Advance Decision to Refuse Treatment guide covers both sides of this divide — with NI-specific templates for drafting a legally binding ADRT, a signing protocol that satisfies common law requirements, and a distribution log to make sure the right people can find your documents in an emergency.
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