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What to do if…
you are unsure who has legal authority to make medical decisions for a critically ill relative

Produced and maintained by PanicStation.org Published: Last reviewed: Editorial policy UK guide

Short answer

Ask the clinical team exactly what decision is needed today, by when, and whether your relative can make that decision themselves. If your relative cannot decide, check for any health or welfare power of attorney, court order, guardian, deputy, advance decision, or written refusal; if there is no valid decision-maker for this decision, the clinical team will usually make a decision using the legal and clinical process that applies where the hospital is.

Do not do these things

  • Don’t assume “next of kin” automatically means legal authority to consent to or refuse treatment.
  • Don’t agree to be “the decision-maker” if you are unsure what authority you have.
  • Don’t sign forms you do not understand or that seem wider than the decision being asked about.
  • Don’t let a family argument move the focus away from what your relative would want, if that is known.
  • Don’t send private documents to wider family chats; give copies only to the ward, ICU team, hospital legal team, or patient advice service if asked.

What to do now

  1. Get the exact question clear.
    Ask: “What decision needs to be made, by when, and what happens if authority cannot be confirmed today?” Ask for the name and role of the person asking and where any document should be sent.

  2. Ask whether your relative can decide this specific issue now.
    Say: “Has their capacity for this decision been assessed today?” If your relative can communicate in any way, ask the team to support them to decide directly before anyone else is treated as speaking for them.

  3. Do a quick document check.
    Ask close family, check papers you already have lawful access to, and tell the ward if you find any of these:

    • a Health and Welfare Lasting Power of Attorney for England or Wales
    • a welfare power of attorney, guardianship order, intervention order, deputyship, or other court order
    • an advance decision, advance directive, written refusal of treatment, or written care preferences
    • any document saying whether several people must act together or can act separately

  4. Give the hospital only what they need to verify authority.
    Tell the ward who is named in the document and provide the copy or access details the hospital asks for. If more than one person is named, ask the team to check whether they must act together or can act separately.

  5. If there is no clear legal decision-maker, ask what decision-making process applies.
    Say: “Please record who has been consulted, what is known about their wishes and values, and the reasoning for the decision.” The wording may be best interests, benefit, or overall benefit depending where the hospital is.

  6. If nobody suitable is available to consult, ask about advocacy.
    Say: “Is there an independent advocate or local equivalent for this decision?” In England and Wales, an Independent Mental Capacity Advocate may be needed for some serious medical treatment decisions when the person lacks capacity and has no suitable family or friends to consult.

  7. Keep family input organised.
    Ask the team whether one person can be the update contact, while making sure the team has the names of others who know your relative well. Write down known wishes, values, faith or cultural needs, previous statements about treatment, and anything your relative strongly would or would not want.

  8. Escalate calmly if there is a serious disagreement.
    Ask for the consultant in charge, the ICU or ward matron, and the hospital patient advice or complaints contact. In England this may be PALS; in Scotland, Wales, and Northern Ireland ask the hospital for the local patient advice, liaison, or complaints route. For unresolved high-stakes disagreement, ask the consultant what urgent legal or court route the hospital would use.

What can wait

  • You do not need to settle inheritance, funeral plans, finances, or long-term family roles now.
  • You do not need to decide future care-home, discharge, or living arrangements during the immediate ICU crisis unless the team says that exact decision is needed today.
  • You do not need to produce a perfect medical history; focus on known wishes, values, and any document that may affect consent or refusal of treatment.

Important reassurance

Being asked about authority can feel frightening, but it does not mean you personally have to make every medical decision. It is responsible to pause, ask what authority is being claimed, and ask the hospital to follow the correct process.

Scope note

These are first steps to stabilise the situation and avoid accidental over-commitment. Later decisions, especially if there is a dispute or possible court involvement, may need specialist legal or clinical help.

Important note

This is general information, not legal, medical, financial, therapeutic, or professional advice. Decision-making law and hospital processes differ between England, Wales, Scotland, and Northern Ireland, and the clinical team should explain what applies in your relative’s situation.

Additional Resources

Closely connected guides that may be useful during the same situation or its immediate aftermath.

About this guide

This guide was produced and is maintained by PanicStation.org using its published editorial process. Official and specialist sources are checked where relevant, and AI-assisted tools may be used for drafting, organisation, and consistency checks. The site operator remains responsible for publication, revision, and removal decisions.

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