living wills terri schiavo and poas

Tuesday, March 22, 2005

Living Wills, Terri Schiavo, and POAs

Dr. Tony made a very good point in the comments below that I thought I should bring to the top so that I could clarify my thoughts and make sure that everyone understands what Dr. Tony is talking about.

Here’s what he said:

Unfortunately, in many cases there is no Living Will, and, even worse (at least from my standpoint as an ER doc), no durable power of attorney for health care to name the one person to whom I can turn for decisions.

When I talk about a Living Will, I assume that part of that document names a durable power of attorney for health care or “healthcare proxy”. The paper is not worth much if it doesn’t name someone who is in charge when you can’t be.

If you have gone to an attorney and had a Power of Attorney drawn up, then you need to read and understand the following. I’m not an attorney and I’m going to paint with a very broad brush here, but many people don’t quite understand what their POA can and can’t do.

Basically, there are three POA functions. Some people have three different POA documents drawn up to cover the three situations, some have one that includes it all. If your POA is only a couple of pages long, then you probably only have one of the three. The most common POA is power to conduct business. It covers checkbooks, banking accounts, mortgages, buying and selling assets. . . We’ll call that a “Business POA”. It has nothing to do with anything other than business stuff. The second is the Durable Power of Attorney for Healthcare which is what Tony mentioned above. This one talks about feeding tubes, breathing machines, heroic measures, and (most importantly) who makes decisions when you can’t. The third (and most rare) is a “Mental Health” Power of Attorney. To be honest, I don’t work in this field and don’t understand all the details of why this one is important. My understanding is that this covers you if you go insane, but I’m betting that my understanding is very limited.

The key here is that few standard POAs that you get from your family attorney deal with anything other than the business/financial stuff. Those that do, usually do a poor job of it. I can’t begin to tell you how many times I have scanned a POA hoping against hope that it mentions something, anything, about medical powers. Many will have one short paragraph near the bottom that says that the POA has the power to admit you to the hospital and pay for your health care. I’ve admitted many patients using this clause and this clause alone, because it was the best we could do. The person doesn’t really have the authority to make Terri Schiavo type decisions, but you work with what you got.

I’ve rambled as usual. All of this to say. If you have a Power of Attorney and feel like that will keep you from being in Terri’s position, you better pull it out of whatever file it’s in and read it very carefully. You probably don’t have as much protection as you think.


Tom Naka

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