Difficult Discussions: End-of-Life Decisions and Why You Need a Medical Power of Attorney

i-care Recently, I cared for an older adult who had no living will or medical power of attorney. Although this woman was an octogenarian, she had been very healthy—until a catastrophic event led to her being hospitalized in the intensive care unit. Because she had been healthy, she didn’t foresee the need to discuss her end-of-life wishes with her family. She also hadn’t designated a medical power of attorney or had a living will drawn up, and her family decided to put her on life support despite the doctor’s opinion that care was futile. She was on life support for an extended amount of time and was resuscitated several times before finally passing. In the end, her family was devastated, feeling that they had extended her suffering needlessly and perhaps hadn’t followed her wishes.

On the other hand, I’ve also had families come back to the ICU feeling very guilty and wondering, “What if?” What if they had decided to put in a feeding tube, or what if they had decided to allow a breathing tube to be placed? Would their loved one have lived if their decisions had been different? The guilt and anguish of both of these situations could have been prevented had the patients discussed their wishes with their family and appointed a medical power of attorney to assure their wishes were followed.

Family conflict can complicate end-of-life decisions

As medical technology has advanced, there have been similar stories in the media over the past decade about the legality and morality of life-saving measures. Currently, the law defers to next of kin to make these decisions when a person is unable to make their own decisions and a legal medical power of attorney is not in place. Spouses, adult children, and parents are considered next of kin, but sometimes these family members disagree about the best interest of their loved one.

When family members don’t agree on a course of treatment for their ill loved one, the bitterness, anger, and division can often become the focus instead of the comfort and well-being of the ill family member. One adult child may think the patient would want a breathing tube, for example, while his or her sibling disagrees. This often leads to a state of limbo where the medical professionals are forced to delay or prolong treatment until either the family comes to a consensus or legal action resolves the issue.  

This was the case with Terri Schiavo, which received national news coverage several years ago. Terri was a woman whose parents and spouse disagreed on removing a feeding tube after a brain injury. Unfortunately, Terri had not outlined her wishes or designated a medical power of attorney, and her case went all the way to the Supreme Court before it was resolved. Difficult decisions like these can lead to bitter conflict among families and even drawn-out legal battles, which is why it is so important to designate a medical power of attorney before any health issue is encountered.

What you need to know when making difficult end-of-life decisions

In any situation, guilt and anguish for the family can be lessened in knowing with certainty that they are carrying out their loved one’s wishes. This can only be accomplished through having discussions about end-of-life wishes and designating the person you want to make decisions for you as your medical power of attorney. Here are some common questions that families have that can help guide you through the process:

What is a medical power of attorney?

A medical power of attorney is someone you appoint in writing to make your medical decisions when you are incapacitated and cannot do so for yourself.

Who is legally considered next of kin?

Spouses, adult children, and parents are considered next of kin. They are legally responsible if there is not a power of attorney designated.

What happens if I don’t have any next of kin?  

This varies by state, but if you have no next of kin and have not designated a medical power of attorney, a hospital ethics committee or court appointed social worker or lawyer would make your medical decisions in the event you are unable.

Don’t I already have a financial power of attorney? Isn’t that enough?

A medical power of attorney differs from a financial power of attorney. You can choose to have the same person in both roles, but if they are different people, their responsibilities do not overlap; the medical power of attorney is in charge of your medical decisions when you are incapacitated to make them. Your financial power of attorney deals with the financial issues of your estate.

Who can be my medical power of attorney?

Any adult that you choose can be your medical power of attorney, except that they cannot be one of your health care providers (doctor, dentist, etc.) because of a potential conflict of interests.

How do I go about the process of designating someone as my power of attorney?

You can choose to go to an attorney and have one drafted, but it is as simple as writing it on a form and having it witnessed by an adult (18 years or older) who is unrelated and unbiased about the decision. These forms can be found online or at your local hospital. Here’s an example of a form available online. Most hospitals also have employees trained in assisting you to complete this and other medical documents for free.

Can I change my mind?

As long as you are mentally competent, you can revoke your medical power of attorney at any time by submitting a letter in writing to your attorney or by destroying the document.

Medical Power of Attorney Is Necessary for Older Adults

Had my friend had a medical power of attorney, a lot of family conflict and stress could have been avoided. Don’t wait until you or your loved one is ill to have these discussions. As an older adult, outline your wishes for your family so they are not put into the difficult role of making these decisions without knowing what you want. For additional help with this or any other issue related to aging, contact us to find out more.

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Dr. Patrick Arbore

Dr. Patrick Arbore, ED.d, is the Director and Founder of the Center for Elderly Suicide Prevention and Grief Related Services. A nationally recognized expert on suicide and a powerful advocate for mental health services for older adults, Dr. Arbore is a role model for living life with true compassion. He's an experienced presenter and has held seminars and workshops on topics relevant to older adults’ mental health.

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