When asked how we envision the end of our lives, most of us could probably conjure up the best-case scenarios for how we want to be taken care of and how we prefer to die.
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But tragedy can strike suddenly and without warning. If you’re not clear about your end-of-life requirements, you could end up leaving many of your loved ones in the dark about which medical interventions you want and how you prefer your final days or hours handled.
Critical care specialist Silvia Perez Protto, MD, MS, MBA, explains why a medical power of attorney agent is a good person to have by your side when unexpected tragedy strikes, and how you can choose who fits that role.
What is a medical power of attorney?
A medical power of attorney — also known as a healthcare proxy, healthcare agent, healthcare power of attorney or durable power of attorney (DPA) for healthcare — is an advance directive or legal document that designates a person you’ve chosen to make medical decisions for you in the event that you can’t make those decisions yourself. If you have a living will in place, this person must also follow those guidelines (more on that in a bit).
Why do you need a healthcare proxy and how does it work?
When a person is incapacitated while under sedation, anesthesia or at the end of life, their medical team will have to ask a surrogate designated by state law to make healthcare decisions for that person. Making these medical decisions at the end of your life is never easy, especially in the heat of the moment. Do they know what you want at the end of your life? Do they know what your wishes are?
Expressing your wishes with loved ones is an important step, but a lot of people rarely discuss them until it’s too late. Helpful resources for navigating these conversations when you’re healthy are conversation guides provided by The Conversation Project. And understanding the difference between hospice and palliative care and how these approaches to your personal treatment plan differ can be beneficial in present and future conversations.
And that’s also where a medical power of attorney agent or healthcare proxy comes into play: This person is usually someone you trust in great detail with your physical, mental and emotional well-being. This person is responsible for making medical decisions for you, and often, the outcome of your situation is dependent on the choices they make. That’s why it’s so important that you choose a healthcare proxy you trust and that you talk to this person about your expectations should the need for their involvement arise.
“The time to have a conversation is now, rather than in the middle of a crisis,” states Dr. Perez Protto. “Anyone can suddenly become critical after a car accident or stroke, and then, you’re called on and have to know what to do in those situations. Making those decisions in the heat of the moment is tough, and no one wants to ever be caught in that situation. But it’s better to be proactive when someone is healthy and well than to have to react to the worst-case scenario.”
Dr. Perez Protto recommends all adults complete a medical power of attorney and revise it:
- Every 10 years.
- If you’ve received a new diagnosis.
- When new situations in your family occur, like a death or divorce or your child turns 18.
What can your healthcare agent do?
Your medical power of attorney agent can make any decision regarding your healthcare in the event you’re unable to make those decisions. They’re legally obligated to act in your best interests. Some of those decisions include:
- The facility or location at which you receive your medical care.
- The kind of medical care you receive, including surgeries, treatments, medications and at-home medical care.
- Which doctors and healthcare providers oversee your care, and any additional staff who oversee your daily activities like eating, sleeping or bathing.
- Where you live, including long-term residential care, assisted living, rehabilitation centers and nursing homes.
When does a medical power of attorney take effect?
Your healthcare proxy or medical power of attorney document goes into effect as soon as you’re incapacitated. Your representative can make medical decisions for you based on their own personal knowledge of how you’d prefer if you’re:
- Under anesthesia.
- Experiencing delirium or confusion.
- In a coma.
- At the end of life on life support and unable to make decisions.
If the person you choose is unavailable at the time of your incapacitation, as part of the medical power of attorney, you can add alternates to take up that role of responsibility in their absence. And if you recover enough to make your own medical decisions, the responsibilities of a medical power of attorney agent ends.
How to create and choose your medical power of attorney
Advance directive forms like a medical power of attorney are easy to create and fill out. You don’t need a lawyer to prepare these documents, but you will need to have it notarized or signed by two witnesses before you file it as part of your medical records. Completing these forms is a bit like signing up for life insurance — it reassures you that you’re prepared for the unexpected. Here are three easy steps to follow in completing these:
- Have a conversation with your family and your healthcare providers. It can be uncomfortable talking about illness and dying with your loved ones. But leaving things to chance can make decisions stressful and difficult for your family if they must act on your behalf. It can also leave some family members burdened by guilt. Because it can be difficult to start the conversation or know exactly what to talk about, Dr. Perez Protto recommends The Conversation Project, a national website that makes it easier to talk with loved ones about your wishes at the end of life, as well as help on how to choose your agent. These conversations should also be had with your primary care provider because your healthcare goals may change over time as your medical needs are met.
- Complete and scan your documents into your medical chart. Once you fill out your documents, you can reach out to your doctor or hospital system to request your documents be added to your medical records. In some states, like Michigan, there are state registries where you can upload your documents so your providers can access them in the case of an emergency.
- Review and revise your documents. Dr. Perez Protto suggests reviewing your medical power of attorney forms and making updates whenever a new life event occurs, or revisiting them every five to 10 years. The people you choose as your agent should also have copies of these forms and any other advance directives on hand, like a living will. “Every time there is a death in your family, every decade, if there’s a new development or diagnosis for you, or if your children turn 18, make sure you revise these documents,” advises Dr. Perez Protto.
Frequently asked questions about a medical power of attorney
Trust us: It’s a lot to consider and a lot to take in, especially when you might feel like you don’t need to have these discussions just yet. But there are a lot of misconceptions about medical power of attorneys and how they work, so we’ve covered some frequently asked questions here:
What’s the difference between a medical power of attorney and a regular power of attorney?
There are different kinds of power of attorneys and they each allow someone else to legally make decisions on your behalf in different sectors of your life:
- A medical power of attorney only legally allows someone to make decisions regarding your healthcare.
- A financial power of attorney only allows someone to make decisions regarding your money, property or business.
- A general power of attorney legally authorizes someone to act on your behalf regarding any situation allowed by law, including legal, financial, health and property matters.
And for each of these, you can determine time limits and boundaries for what’s allowed to happen when and under which circumstances.
What happens if I don’t have a medical power of attorney?
If you don’t have a medical power of attorney filed, your state laws determine who’s allowed to make your medical decisions. Laws vary based on location, and laws vary from country to country. For example, in the United States, in Ohio, medical decisions can be made on your behalf based on the following order and who’s currently available when a decision needs to be made:
- Your spouse.
- Your adult child or the majority of your adult children.
- Your parents.
- Your adult sibling or the majority of your adult siblings.
- Your nearest relative.
But in Florida, a close friend who helps with your medical care can also be contacted.
If you’re unsure of what’s available or who’s designated to make medical decisions on your behalf without these forms, make sure you check with your local, state and country laws to determine which forms and requirements are available to you.
“The power of attorney is like a safety net and it’s something I recommend every adult doing, especially if you live with someone and you are not married, or if you are separated but not divorced,” encourages Dr. Perez Protto. “If you don’t have a document, state law tells doctors who we should talk to and who is going to make decisions.”
Medical power of attorney vs. a living will
A medical power of attorney specifies who enacts all medical decisions for you, while a living will is a document that states you do not want to be kept alive with artificial life support if you have a terminal condition and you are incapacitated, or you are permanently unconscious.
“If you have a living will signed and you’re determined terminally ill by two physicians, you’re telling your doctors to change goals of care to comfort only and sign a do-not-resuscitate order,” explains Dr. Perez Protto.
A living will also contains your preference for organ or tissue donation upon your death.
Can a healthcare proxy be revoked?
You can make changes to your medical power of attorney any time you wish to do so.
To make changes or remove someone as your medical power of attorney agent, you’ll have to file a revocation notice and have it notarized, or you can create a new medical power of attorney that designates a new person. You just have to make sure you file the new forms at the institution where you receive healthcare.
Healthcare providers, hospice workers and end-of-life doulas work in tandem to assist anyone who’s interested in taking steps to solidify their future healthcare needs. If you’re unsure of your state laws regarding advance directives or medical power of attorneys, the American Association of Retired Persons (AARP) allows you to download advance directives you need for your state.
Ultimately, end-of-life conversations are conversations about how you want to live until the end, and they should be had long before a problem arises. The sooner you pick your medical power of attorney agent, fill out your advance directives and have these conversations with your loved ones, the more confident you can feel about unexpected circumstances in the future and the way your life at the end will be handled.
“Everyone has a right to make their own decisions about end-of-life care,” stresses Dr. Perez Protto. “It’s important to be very clear about what you want. We want you to be prepared and not thrown into a situation where someone has to make decisions without the right information.
“We should all have conversations about what matters most to us so we can live to the fullest until the end.”