Advance Directives - Durable Power Of Attorney For Health Care

A durable power of attorney for health care, also called a medical power of attorney, is another part of an advance directive. It designates a health care agent or proxy authorized to make medical treatment decisions on behalf of a patient who can no longer make these decisions TABLE 7.1 Advance health-care directivefor himself or herself. (See Table 7.1, Part 1: Power of Attorney for Health Care.) The role of this agent or proxy begins as soon as the physician certifies that a patient is incompetent to make his or her own decisions. The agent's role may or may not be limited to end-of-life care.

While a living will provides specific directions about medical treatment, it cannot address every possible future medical situation. Most standard living wills apply only to limited circumstances, such as terminal illness or permanent coma. There are, however, many medical TABLE 7.1 Advance health-care directive [CONTINUED]treatments that require decision making. Examples of these are surgical procedures, diagnostic tests, blood transfusion, the use of antibiotics, radiation therapy, and chemotherapy.

A durable power of attorney for health care is generally more flexible than a living will. It allows individuals to appoint proxies (agents) who will use their judgment to respond to unforeseen situations based on TABLE 7.1 Advance health-care directive [CONTINUED] "Advance Health-Care Directive," in Patient Self-Determination Act: Providers Offer Information on Advance Directives but Effectiveness Uncertain, U.S. General Accounting Office, August 1995, http://www.gao.gov/archive/1995/he95135.pdf (accessed November 7, 2005)their knowledge of the patient and the patient's values and beliefs. Because there is no uniform advance directive statute nationally, the rights of health care agents vary across states. Limits on agent's powers in each state and the District of Columbia as of September 1, 2004, are shown in Table 7.2.

In the Absence of Durable Power of Attorney for Health Care

Physicians usually involve family members in medical decisions when the patient has not designated a health care proxy in advance. Many states have family consent or surrogate consent laws for this purpose. (See Figure 7.3.) Some have laws that designate the order in which family members may assume the role of surrogates or decision makers. For example, the spouse may be the prime surrogate, followed by an adult child, then the patient's parent, etc.