A health care power of attorney is a document in which one person (the principal) names another person (the health care agent, proxy, representative, or surrogate, depending on the state) to make decisions about health care in the event the principal losses capacity to make health care decisions. Like the living will, this document may be called by different names in different states.
A health care power of attorney differs from a living will in that it focuses primarily on the decision-making process and not on a specific decision. When writing a living will, no person can anticipate all possible circumstances. Thus, the power of attorney for health care can cover as broad a range of health care decisions as the principal desires.
Once in effect, the agent can act in the here-and-now, review the medical record, serve as an advocate, discuss care and questions with the medical staff, and decide what the principal would want or what is in the best interest of the principal if the principal's wishes are not known. The health care power of attorney can include a living will provision—a description of health care preferences—or any other instructions but should, preferably, do so only as guidance for the agent, rather than as a binding instruction.
The agent should be selected with great care. A person who strongly wishes to avoid aggressive medical treatment should not name an agent who might not carry out such wishes. For example, selecting as agent a person who believes that every possible medical intervention should be used to prolong life, or a spouse whose emotional state might make it difficult to limit or terminate care, may not be wise. A better choice might be a trusted associate, advisor, or a longtime friend.
An ideal agent has the ability to talk effectively with health care practitioners and act as a strong mediator and advocate when faced with resistance from the principal’s family members, friends, or health care practitioners. Principals should discuss the goals, values, and wishes they want agents to use as guidance, because agents will need all the guidance possible when making decisions that can be extremely difficult. In addition, a principal should make sure that the agent is willing to take on this responsibility before the principal names the person as agent.
In most states, two or more people may be named to serve as agents together (jointly) or alone (severally). However, such joint appointments can create conflicts and complications and should probably be avoided or discussed with an attorney. If feasible, the health care power of attorney should name an alternate or successor agent in case the first-named person is unable or unwilling to serve.
The law of each state describes the rules and procedures necessary for making a valid health care power of attorney as well as living will. These rules should be followed carefully. Most states require two qualified witnesses to sign the document, and some permit notarization as an alternative. A principal who has capacity can cancel the health care power of attorney at any time. The choice of agent does not have to be permanent. If circumstances change, the principal can and should create a new health care power of attorney and/or name a new agent.
The health care power of attorney is important for younger as well as older adults because a health care agent can act during periods of temporary clinical incapacity as well as during more likely permanent incapacity near the end of life. It is especially important for anyone who wants someone other than next of kin to control decision making (for example, a partner, friend, or anyone else legally unrelated). It is the only way, outside of a court proceeding (which is a complicated process), to give that person the legal authority to make health care decisions and to ensure rights of visitation and access to medical information.
Ideally, copies of the living will or health care power of attorney should be given to every doctor providing care for the principal and to the hospital upon admission. Copies should also be placed in the principal’s permanent medical record, given to the principal’s appointed agent and lawyer, and placed with important papers. People should also provide copies to other close family or friends who will likely be involved during serious illness. This helps avoid surprise and controversy when difficult decisions have to be made by the agent. Web-based databases that store information about peoples' advanced directives and that can be accessed by health care practitioners are becoming increasingly available. Advance directive smartphone apps are also available, allowing people to store advance directives, share them with family members, and send them electronically to doctors.
Having multiple advance directives or ones that are overly complicated can create confusion. If there is both a living will and a health care power of attorney, the principal should stipulate which should be followed if the documents seem to conflict. In general, a health care power of attorney is preferable if the principal has a trusted person to appoint as agent.
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This form is a combined durable power of attorney for health care and a living will (in some jurisdictions). With this form, you can name someone to make medical decisions for you if in the future you're unable to make those decisions yourself. You can also say what medical treatments you want and what medical treatments you don't want if in the future you're unable to make your wishes known.
Read each section carefully. Before you fill out the form talk to the person you want to name, to make sure that he/she understands your wishes and is willing to take the responsibility. Write your initials in the blank spaces before the choices you want to make. Write your initials only beside the choices you want under Parts 1, 2 and 3 of this form. Your advance directive should be valid for whatever part(s) you fill in, as long as it is properly signed.
Add any special instructions in the blank spaces provided. You can write additional comments on a separate sheet of paper, but you should write on this form that there are additional pages to your advance directive. Sign the form and have it witnessed. Give copies to your doctor, your nurse, the person you name to make your medical decisions for you, people in your family and anyone else who might be involved in your care. Discuss your advance directive with them.
Understand that you may change or cancel this document at any time.
Advance directive—A written document (form) that tells what a person wants or doesn't want if he/she in the future can't make his/her wishes known about medical treatment.
Artificial nutrition and hydration—When food and water are fed to a person through a tube.
Autopsy—An examination done on a dead body to find the cause of death.
Comfort care—Care that helps to keep a person comfortable but doesn't make him/her get well. Bathing, turning and keeping a person's lips moist are types of comfort care.
CPR (cardiopulmonary resuscitation)—Treatment to try to restart a person's breathing or heartbeat. CPR may be done by pushing on the chest, by putting a tube down the throat or by other treatment.
Durable power of attorney for health care—An advance directive that names someone to make medical decisions for a person if in the future he/she can't make his/her own medical decisions.
Life-sustaining treatment—Any medical treatment that is used to keep a person from dying. A breathing machine, CPR, and artificial nutrition and hydration are examples of life-sustaining treatments.
Living will—An advance directive that tells what medical treatment a person does or doesn't want if he/she is not able to make his/her wishes known.
Organ and tissue donation—When a person permits his/her organs (such as the eyes or kidneys) and other parts of the body (such as the skin) to be removed after death to be transplanted for use by another person or to be used for experimental purposes.
Persistent vegetative state—When a person is unconscious with no hope of regaining consciousness even with medical treatment. The body may move and the eyes may be open, but as far as anyone can tell, the person can't think or respond.
Terminal condition—An ongoing condition caused by injury or illness that has no cure and from which doctors expect the person to die even with medical treatment. Life-sustaining treatments will only prolong the dying process if the person is suffering from a terminal condition.
Complete this portion of advance directive form
I, _____________________________________________________________, write this document as a directive regarding my medical care.
In the following sections, put the initials of your name in the blank spaces by the choices you want.
PART 1. My Durable Power of Attorney for Health Care
______ I appoint this person to make decisions about my medical care if there ever comes a time when I cannot make those decisions myself. I want the person I have appointed, my doctors, my family and others to be guided by the decisions I have made in the parts of the form that follow.
Name: ______________________________________________________________________________
Home telephone: ____________________________ Work telephone: _______________________
Address: ____________________________________________________________________________
____________________________________________________________________________
If the person above cannot or will not make decisions for me, I appoint this person:
Name: ______________________________________________________________________________
Home telephone: ___________________________ Work telephone: ________________________
Address: ____________________________________________________________________________
____________________________________________________________________________
______ I have not appointed anyone to make health care decisions for me in this or any other document.
These are my wishes for my future medical care if there ever comes a time when I can't make these decisions for myself.
A. These are my wishes if I have a terminal condition
Life-sustaining treatments
_____ I do not want life-sustaining treatment (including CPR) started. If life-sustaining treatments are started, I want them stopped.
_____ I want the life-sustaining treatments that my doctors think are best for me.
_____ Other wishes _________________________________________________________________________
Artificial nutrition and hydration
_____ I do not want artificial nutrition and hydration started if they would be the main treatments keeping me alive. If artificial nutrition and hydration are started, I want them stopped.
_____ I want artificial nutrition and hydration even if they are the main treatments keeping me alive.
_____ Other wishes _________________________________________________________________________
Comfort care
_____ I want to be kept as comfortable and free of pain as possible, even if such care prolongs my dying or shortens my life.
_____ Other wishes _________________________________________________________________________
B. These are my wishes if I am ever in a persistent vegetative state
Life-sustaining treatments
_____ I do not want life-sustaining treatments (including CPR) started. If life-sustaining treatments are started, I want them stopped.
_____ I want the life-sustaining treatments that my doctors think are best for me.
_____ Other wishes _________________________________________________________________________
Artificial nutrition and hydration
_____ I do not want artificial nutrition and hydration started if they would be the main treatments keeping me alive. If artificial nutrition and hydration are started, I want them stopped.
_____ I want artificial nutrition and hydration even if they are the main treatments keeping me alive.
_____ Other wishes _________________________________________________________________________
Comfort care
_____ I want to be kept as comfortable and free of pain as possible, even if such care prolongs my dying or shortens my life.
_____ Other wishes _________________________________________________________________________
You have the right to be involved in all decisions about your medical care, even those not dealing with terminal conditions or persistent vegetative states. If you have wishes not covered in other parts of this document, please indicate them below.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_____ I do not wish to donate any of my organs or tissues.
_____ I want to donate all of my organs and tissues.
_____ I only want to donate these organs and tissues: ___________________________________________
_____ Other wishes _________________________________________________________________________
_____ I do not want an autopsy.
_____ I agree to an autopsy if my doctors wish it.
_____ Other wishes _________________________________________________________________________
C. Other statements about your medical care
If you wish to say more about any of the choices you have made or if you have any other statements to make about your medical care, you may do so on a separate piece of paper. If you do so, put here the number of pages you are adding: _____________
You and two witnesses must sign this document before it will be legal.
By my signature below, I show that I understand the purpose and the effect of this document.
Signature ________________________________________________________ Date ____________________
Address ___________________________________________________________________________________
B. Your witnesses' signatures
I believe the person who has signed this advance directive to be of sound mind, that he/she signed or acknowledged this advance directive in my presence and that he/she appears not to be acting under pressure, duress, fraud or undue influence. I am not related to the person making this advance directive by blood, marriage or adoption nor, to the best of my knowledge, am I named in his/her will. I am not the person appointed in this advance directive. I am not a health care provider or an employee of a health care provider who is now, or has been in the past, responsible for the care of the person making this advance directive.
Witness #1
Signature ________________________________________________________ Date ____________________
Address ___________________________________________________________________________________
Witness #2
Signature ________________________________________________________ Date ____________________
Address ___________________________________________________________________________________