uk Death, bereavement & serious family crises medical decision-maker • who can consent treatment • critically ill relative • intensive care decisions • hospital asked to confirm authority • next of kin vs legal authority • next of kin authority • health and welfare lpa • lasting power of attorney health • court of protection deputy • best interests decision • mental capacity act process • family disagreement about decisions • no paperwork who decides • confirm decision-making rights • relative lacks capacity • advance decision refuse treatment • imca advocate • urgent consent questions • proxy for medical decisions

What to do if…
you are asked to confirm who has medical decision-making authority for a critically ill relative

Short answer

Ask the clinical team exactly what decision is needed today, then identify whether your relative still has capacity; if not, check for a Health and Welfare Lasting Power of Attorney (LPA) or a court-appointed deputy. If there is no legal decision-maker, the team usually makes the decision in your relative’s best interests while consulting those close to them.

Do not do these things

Don’t assume “next of kin” automatically has legal authority to consent to or refuse treatment.
Don’t sign hospital forms you don’t understand or that seem to give wider authority than you intend.
Don’t argue the medical details in the corridor; ask for a short, structured discussion (and notes) so facts don’t get lost.
Don’t share private documents or IDs widely—give them only to the ward team or hospital legal/patient services as requested.
Don’t agree to be “the decision-maker” if you’re unsure; it’s okay to say you need to check paperwork first.

What to do now

Pause and get the exact ask in writing (or repeat it back).
Ask: “What decision needs to be made, by when, and what happens if we can’t confirm authority today?”
Request the name/role of the person asking and where to send documents.
Clarify capacity right now (for this specific decision).
Ask the consultant/registrar or senior nurse: “Do you think they can decide this themselves today?”
If your relative can communicate, ask the team to speak with them directly (even briefly) before anyone else acts.
Do a fast document check: LPA / deputyship / advance decisions.
Ask family members (and check your relative’s papers/phone if you already have lawful access) for:
- A Health and Welfare LPA (and who the attorneys are)
- A Court of Protection order appointing a deputy (if one exists)
- Any Advance Decision to Refuse Treatment (ADRT) or written care preferences
  If multiple people claim authority, ask each to provide the document or official confirmation.
If there’s an LPA, confirm it the way the hospital needs.
Tell the ward who the attorney(s) are and provide what the hospital requests (commonly a copy of the LPA and ID).
If attorneys are joint, decisions may need to be made together; if joint and several, one may be able to act—ask the team what they require to record this safely.
If there is no legal decision-maker, ask for the “best interests” process and a documented plan.
Say: “If there’s no LPA/deputy, please record who you consulted, what you understand their wishes/values to be, and the best-interests reasoning.”
Ask for a best-interests discussion/meeting if the decision is significant or the family is split.
If your relative has no appropriate family/friends to consult, ask about an IMCA.
If they lack capacity and there is no suitable person to consult, ask: “Does this decision qualify for an Independent Mental Capacity Advocate (IMCA) referral?”
IMCA involvement applies to specific types of decisions and won’t fit every situation—ask the team to confirm eligibility.
Reduce conflict quickly if relatives disagree.
Use one sentence: “Let’s keep this about what they would want.”
Ask the team to speak to one nominated spokesperson for updates, but keep a written list of everyone who should be consulted.
If there’s a serious dispute, escalate calmly and early.
Ask for: the consultant in charge, the ward/ICU matron, and the hospital’s patient advice/feedback service (often PALS in England, with different equivalents in Scotland, Wales and Northern Ireland).
If needed, ask what the route is for urgent legal advice or court involvement for unresolved, high-stakes disagreements.

What can wait

You do not need to settle inheritance, funeral plans, or family “who’s in charge” long-term right now.
You do not need to write a perfect summary of their whole medical history—focus on their known wishes, values, and any relevant paperwork.
You do not need to decide future living arrangements or care home options during an ICU crisis.

Important reassurance

It’s normal to feel thrown by this question—hospitals ask it because they must record who can legally speak for someone if they can’t decide themselves. Needing time to find paperwork, or asking the team to follow a clear process, is a responsible step, not a delay.

Scope note

These are first steps to confirm decision-making authority and avoid accidental over-commitment. Later steps (especially if there’s conflict or court involvement) may need specialist legal advice.

Important note

This is general information, not legal or medical advice. UK rules differ between parts of the UK and depending on the type of decision and documents in place. Hospital teams can explain what they need to record and the process they must follow in your relative’s situation.

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What to do if…you are asked to confirm who has medical decision-making authority for a critically ill relative