The Importance of a Health Care Power of Attorney

The need to have someone make medical decisions for you is not always predictable. I can offer one example.

While Lucille suffered from several chronic conditions for years, her overall health seemed to stay on a more or less even keel. Only in her 70s, she knew that she should have a health care power of attorney in place. Of course her husband of 40 plus years knew what she wanted, but he traveled often without her, given her limitations. Even if he was at her side, she knew that having the healthcare proxy set up was the sensible thing to do. 

As fate would have it, Lucille’s health declined rapidly last autumn surprising her entire family. Dehydration, altered blood chemistry and diminished liver and kidney function landed her in ICU in a complete state of confusion. Unable to make care decisions, medical staff concluded the time had come to activate the health care power of attorney. 

This type of situation is not uncommon. The best idea is to plan for the future,

First, what is a healthcare power of attorney (POA)?

It’s important to know that a health care power of attorney functions very differently than a financial power of attorney and should not be confused.
A health care power of attorney (also called a health care or medical proxy) allows you to appoint someone to make medical decisions for you if you are unable to make those decisions yourself. A healthcare proxy or agent must be 18 or older but does not have to be a relative or someone with medical knowledge. You can find Wisconsin Health Care POA forms online.

Tips for choosing your proxy

The best candidate is someone who can be clearheaded during times of stress and is comfortable talking to doctors. He or she should be assertive enough to ask the right questions and most importantly unwavering in his or her commitment to you and making decision for you on your behalf even if his or her beliefs are different from yours. While some may be inclined to choose their spouse as their proxy, keep in mind that a spouse may be called upon to make some very emotional decisions.  Depending upon the kind of decision, it could be difficult for a spouse to do.  Another reason that a spouse may not be the ideal choice is in the event that both spouses are incapacitated — such as a result of an auto accident.  Remember that POA paperwork allows you to name multiple agents in succession, and it would be wise to make multiple designations just for the reasons stated.

Advance directives do not expire but should be reviewed from time to time.

For example, the person you have chosen may have died and you need to select a new proxy. If you have selected more than one person in a line of succession (common with children) one may have moved away or is no longer a good selection. Divorce may be another reason to change your health care agent. Certain diagnoses or a change in your overall health could prompt you to feel different about your end of life directives.  

How it gets activated

A healthcare power of attorney by definition must be durable. Legally this means that the power of attorney goes into effect even if the grantor becomes incapacitated. A standard power of attorney without a durability provisions ceases to be effective if the grantor becomes incapacitated. (A financial power of attorney can be standard or durable.) 

So a durable power of attorney for health care does not become effective simply because you sign the document. This type of power of attorney activates only when you are unable to make medical decisions for yourself. While you can stipulate that you do not require a medical recommendation to permit your agent to make health care decisions, in most situations a doctor’s written confirmation of your incompetence is required to activate the directive. Most hospitals and long term care communities require two physicians to make this determination.

How does a doctor decide if you're mentally competent?

In general, the doctor will consider whether you have an understanding of the subject area covered by the power of attorney, whether you understand the implications and importance of the matters involved, and whether you can make and communicate reasoned choices.

How to deactivate a health care power of attorney

Hospitals often have a set procedure to activate health care POAs but don’t necessarily have the same procedures in place to deactivate them upon discharge — even if the person is deemed competent.  Upon discharge you need to ask the status of your health care POA to make sure that it doesn’t remain unnecessarily in place.  This is just another important reason to periodically review that your paperwork is current.  

Lucille was fortunate that her health crisis passed and she eventually was able to leave the hospital. (Upon discharge, because she was deemed competent and able to make healthcare decisions, her POA was deactivated.)  As a result of this health episode, Lucille and her husband decided to move into a senior living community where they both could enjoy a vibrant, active lifestyle and Lucille could benefit from the additional supports provided through their assisted living program.  They both have a durable power of attorney in place, should the need ever arise again.