It’s not always deciding whether to ‘pull the plug’
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 (POA), 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.
“People tend to think that they have to automatically assign their spouse or a son or daughter or family member,” said Brianne Barr, director of social work at Seneca Hill Manor. “That’s not really the case. I always advise people to choose people as their medical POA who will adhere to their wishes when they’re not able to make decisions for themselves. Sometimes, it’s too hard for a spouse or child to follow those wishes as it’s a very special person. It’s their loved one.”
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.
“If they’re close by it’s helpful but you don’t necessarily have to pick someone who’s local as long as there’s way to get a hold of them,” Barr 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.
Christine Stanford, senior director of operations and finance at Loretto, encourages people completing a healthcare proxy form to discuss in detail end-of-life care, including artificial supports, resuscitation and quality of life issues.
“We always encourage our residents to have discussions with their health care proxy while they are still capable of decision making,” Stanford said. “Discussions should include whether they want to be intubated, receive hydration and nutrition (feeding tubes), receive antibiotics for infections.”
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.
“The healthcare proxy only acts when you’re able to act or make decisions on their own,” Stanford said.
She also encourages residents to complete a medical order for life-sustaining treatment (MOLST) form that has been completed with a healthcare provider’s input.
“This document is subject to review and change as the individual’s healthcare needs change,” Stanford said.
In addition to the medical power of attorney, a back-up person is also recommended. 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.