The clearer you can be, the better
By Deborah Jeanne Sergeant
As part of end-of-life planning, it is important to complete a healthcare proxy.
Named in this document is the medical power of attorney, a person who has the legal authority to make healthcare decisions for you should you be incapable of making them because of an illness or injury. Selecting this person is a decision to make with care.
“Make sure everyone understands who this person is,” said Margaret Tomaka, executive vice president of Specific Solutions in Buffalo. “If you have a medical condition where you can’t speak for yourself, you need a POA. The medical community is so overworked. They can’t keep up with all the information in patients’ files. You need someone who’s familiar with everything and knows about it.”
The medical power of attorney may also be called a durable power of attorney for healthcare or a healthcare agent. But the role is different from a financial power of attorney, which is someone who can make financial decisions and pay bills for a person who is incapacitated.
“Pick someone whom you feel close to and trust, someone with whom you feel you can share your wishes and feel comfortable that they’ll carry them out,” said Kristin Surdej, licensed master of social work and care manager certified with Laping, Surdej, Associates, LLC, geriatric care managers in Cheektowaga.
Surdej encourages people completing a healthcare proxy form to discuss in detail end-of-life care, including artificial supports, resuscitation and quality of life issues.
“It doesn’t have to be someone who lives close by or someone with medical knowledge, though it’s helpful to the healthcare team that it’s someone who can be reached easily and knows your wishes,” she said.
Although it can be helpful, the individual does not have to possess medical knowledge. Trust and a thorough understanding of your wishes is much more important.
“If you can, complete Medical Orders for Life-Sustaining Treatment form,” Surdej said. “Go through those questions so if and when that comes up in a terminal situation, they’d know what your answers would be.”
She also urges those completing the form, known as the MOLST, to discuss it and share a copy with the medical POA selected. A copy should also be stored in the glove compartment, and it should become part of the medical records.
“Every hospital trip, whether inpatient or out-patient, take a copy,” Surdej said.
Family members represent an easy choice for a medical POA, but that is not a requirement. In some cases, it may be a bad idea altogether.
“That person has to be comfortable being in that position,” said Roxanne Sorenson, owner of Elder Care Solutions of WNY in Amherst. “Maybe, emotionally your daughter can’t do it. You have to have an in-depth conversation.”
Many years ago, she had a patient whose medical POA would not follow the healthcare proxy because the agent felt guilty for “killing her mother.” The patient lingered for 10 years on life support in an incapacitate state, which was not what she had stated she wanted.
“Make sure that person understand what you want and they can do this,” Sorenson said. “It’s very emotional but the person has to be able to follow through. It may not be your loved ones or significant other or children.”
It’s perfectly legal to name a friend or to pay an attorney to carry out the wishes in the healthcare proxy.
While most people think of medical power of attorney agents as deciding to “pull the plug” or not, they may also be called upon as a point of contact in case of a hospitalization or out-patient surgery for organizing post-discharge or postoperative care or in case of complications.
“It’s always good to have a back-up, a contingency plan,” said Adam Bojak, attorney at the Law Office of Richard J. Morrisroe in Buffalo. “When I do these forms, I ask everyone to give me a back-up in case the primary agent is unavailable so someone can step up.”
Younger people tend to choose their spouse and parents; older adults tend to select their spouse and a child. But selecting more than one child can cause rifts if the plans are not made clear.
Bojak encourages clients to review their healthcare proxy form along with their estate plan every five or so years. He cautioned against forms from the internet, as they may not be legally sound and executed according to state law.
“The template I use includes leeway to say that we don’t require you to do X Y or Z but it gives you the authority to do so,” Bojak said.
For example, they may want to wait on ending life-sustaining measures so that family members who are out of town have an opportunity to come say goodbye.
Healthcare Power of Attorney
According to Psychology Today, the responsibilities of a healthcare power of attorney could include:
- Deciding on medical care, including medical tests, medication, or surgery
- Requesting or declining life-support treatments
- Authorizing or refusing medication, procedure and pain management
- Choosing which hospital, medical facility, nursing home, or hospice is best
- Understanding and asking questions about your condition, and available treatment options
- Reviewing your medical history chart
- Communicating with your family members about your condition and treatment plan
- Requesting second opinions or alternative medical care/treatment options
Suggested topics to discuss
- Allergies, food and medicine, other
- Chronic conditions, any ongoing medical conditions
- Previous surgeries, when and why
- Current medications, when and why
- Medical treatments that you would prefer not to receive, why
- End-of-life wishes
- Life-support treatments that you would or would not like to receive
- What your feelings are regarding mechanical breathing (respirator), cardiopulmonary resuscitation, artificial nutrition and hydration, hospital intensive care, pain management, chemo or
- radiation therapy, and surgery?
- Would you want antibiotics if you developed a life-threatening infection?
- Would you prefer to remain at home if possible, or be in a hospital or hospice environment?
- Any religious or spiritual wishes