Durable Power of Attorney for Health Care

Modern technology has made it possible for physicians to save lives that evenjust a few years ago would have been lost. Although such medical advances have given us many reasons for celebration, they have also rasied a variety ofquestions about whether the essence of life should be maintained if the quality of life is lacking. That is, are patients whose bodies are being kept alive by machine, although they will never recover to lead a normal life, truly enjoying life?

In response to cases such as that of Karen Ann Quinlan, a New Jersey woman who lingered in a coma for 10 years after drinking alcohol mixed with asmall amount of Valium and Librium, the medical and legal communities devisedthe advance directive. An advance directive allows a person---before he or she enters surgery or even before falling ill---to make his or her wishes regarding life-sustaining care known. The durable power of attorney for health care (DPAHC) is one form of an advance directive. The other is the living will.

The two types of advance directive are similar in that, as stated, they allowa person to tell his or her doctor and family what kind of care they want tohave and what measures they would consider too extreme. For example, a termanilly ill cancer patient may not want his doctor or hospice nurses toadminister cardiopulmonary resuscitation (CPR) if he goes into cardiacarrest. He could use either the living will or the durable power of attorneyto inform his caregivers and his family.

However, by using the durable power of attorney for health care, this cancerpatient could go beyond just stating his wishes: he can name someone he trusts to make medical decisions for him if he becomes unable to do so for himself. This decision-maker---usually a spouse, adult child, or a sibling---is called the "agent." Should the cancer patient unexpectedly fall into a coma, forexample, the agent would advise the patient's caregivers about what to do forhim---whether he would want to be maintained on a respirator, for example, or receive nourishment through a feeding tube.

The durable power of attorney for health care is more thorough and more flexible than the living will. The living will allows the patient to state the action to be taken in specific cases; however, if the unexpected occurs, the living will does not cover it and the caregivers and family are left to guess atwhat to do. By naming an agent, the patient will be sure that someone will act on his or her behalf even in the most unexpected of cases---if a stroke leaves the person unable to talk or walk, for example, or on life support withdim prospects for recovery.

The key for making this agent-patient relationship work, of course, is for the patient to discuss his or her thoughts and feelings about extraordinary lifesaving measures with the agent. Among the questions the patient first needsto ask him- or herself, and then talk over with the selected agent, are:

  • How important is it for me, in terms of quality of life, to be able to communicate?
  • Does quality of life, for me, mean being kept alive on a respirator, or fed through a feeding tube?
  • How important is it for meto be able to feed myself, bathe myself, or dress myself? Would I be willingto accept help with these everyday tasks?
  • Would I be willing to livewith a colostomy, or a pacemaker?
  • Does quality of life, for me, mean being in touch with reality?

Of course, there are many other aspects of care to consider, and for information it's best for a patient to turn to his or her doctor. Like most people, doctors find it uncomfortable to bring up the subject of death, and a survey of physicians showed that many physicians won't mention advance directives until the patient brings them up. However, discussing and preparing a durable power of attorney for health care doesn't mean that you'll soon be needing it, despite what supersition might say!

Doctors' offices and hospitals can provide forms on which to base a durable power of attorney for health care, and computer programs that include personallegal forms may also include a form to use for a DPAHC. It may also be worthwhile to speak to an attorney, although the DPAHC is not a complicated document to create.

The agent should understand that this document gives him or her influence only over medical decisions; financial or other legal issues are outside of itsscope.

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