Medical Power of Attorney: The Clearer, The Better

By Deborah Jeanne Sergeant

As part of end-of-life planning, it is important to complete a healthcare proxy. Named in this document is the medical power of attorney, a person who has the legal authority to make healthcare decisions for you should you be incapable of making them because of an illness or injury. Selecting this person is a decision to make with care.

“It should be someone you know who will be available, whether local or far away but available by phone,” said Carol Brownstein-Evans, Ph.D., professor at Nazareth College. “It should be someone who understands your wishes. A healthcare proxy and the individual can review about life decisions, like DNR orders and what it means.”

The medical power of attorney may also be called a durable power of attorney for healthcare or a healthcare agent. But physician Adam Herman, chief of palliative medicine at Rochester Regional Health, pointed out that the role is different from a financial power of attorney, which is someone who can make financial decisions and pay bills for a person who is incapacitated.

“Choose someone who knows your wishes for medical care, how invasive or aggressive you wish to be and what your personal values or religious values would indicate,” Herman said. “Most importantly, choose someone who would respect your decisions for care. It doesn’t have to be a spouse or a family member, although it often is.”

Although it can be helpful, the individual does not have to possess medical knowledge. Trust and a thorough understanding of your wishes is much more important.

Herman encourages people completing a healthcare proxy form to discuss in detail end-of-life care, including artificial supports, resuscitation and quality of life issues.

It doesn’t have to be someone who lives close by or someone with medical knowledge, though it’s helpful to the HC team that it’s someone who can be reached easily and knows your wishes.

“Often, emotion can cloud decisions for these people,” Herman said. “When you talk with them, it’s important that they understand that these are your instructions and wishes and that you give them permission to follow the instructions you’ve given them. The clearer you can be, the better. Healthcare proxy doesn’t require a lawyer to make. Designating one requires filling out a form and it does need to be witnessed by two people. Those two people cannot be the people named.”

In addition to the medical power of attorney, a back-up person is also recommended. Younger people tend to choose their spouse and parents; older adults tend to select their spouse and a child. But selecting more than one child can cause rifts if the plans are not made clear.

While most people think of medical power of attorney agents as deciding to “pull the plug” or not, they may also be called upon as a point of contact in case of a hospitalization or outpatient surgery for organizing post-discharge or postoperative care or in case of complications.

Healthcare Power of Attorney

According to Psychology Today, the responsibilities of a healthcare power of attorney could include:

  • Deciding on medical care, including medical tests, medication, or surgery
  • Requesting or declining life-support treatments
  • Authorizing or refusing medication, procedure and pain management
  • Choosing which hospital, medical facility, nursing home, or hospice is best
  • Understanding and asking questions about your condition, and available treatment options
  • Reviewing your medical history or chart
  • Communicating with your family members about your condition and treatment plan
  • Requesting second opinions or alternative medical care and treatment options

Suggested topics to discuss

  • Allergies, food and medicine, other
  • Chronic conditions, any ongoing medical conditions
  • Previous surgeries, when and why
  • Current medications, when and why
  • Medical treatments that you would prefer not to receive, why
  • End-of-life wishes
  • Life-support treatments that you would or would not like to receive
  • What your feelings are regarding mechanical breathing (respirator), cardiopulmonary resuscitation, artificial nutrition and hydration, hospital intensive care, pain management, chemo or radiation therapy, and surgery?
  • Would you want antibiotics if you developed a life-threatening infection?
  • Would you prefer to remain at home if possible, or be in a hospital or hospice environment?
  • Any religious or spiritual wishes