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Durable Power of Attorney for Healthcare – How to Make the Selection

By Sid Adelman

The closest most of us will come to experience torture will be at the end of our lives in we end up in the intensive care unit (ICU), a skilled nursing facility or in a dementia ward. The Institute of Medicine’s Key Findings and Recommendations in its Dying in America report suggests one way to avoid this nightmare scenario is to  designate “a surrogate/decision maker.” This step is important because this surrogate may be your only hope if you are unable to speak for yourself for avoiding the suffering and torture associated with unwanted and unnecessary medical procedures, tests and treatments that may be invasive, painful, or fraught with complications.

What is a Durable Power of Attorney (DPOA) for Healthcare

Your designated person or persons who will speak for you, but only if you are unable to speak for yourself or make medical decisions for yourself.  You might be in a coma, you might be sedated or you might be so confused that you are unable to make a rational decision. This designated person or persons will make sure your wishes are honored. 

Isn’t my advance directive for healthcare enough?

Even though your doctor and the hospital have your advance directive on file, it might be overlooked, it might be inaccessible, it might not be apparent or it might be purposely ignored and that’s why you need your DPOA to be available, giving him/her the power to make decisions – with the understanding of what you want.  

How to select the DPOA

The optimal choice would be:

  1. A person who will do whatever is necessary to honor your wishes. A person with a backbone, willing to stand up to the medical establishment, to family and friends who “know better what you (or God) would want.”
  2. A person who is mentally competent, healthy, perhaps younger, forceful even as they age and be geographically accessible. 
  3. It does not have to be a spouse or family member. Sometimes a dispassionate and unemotional friend would be a better choice.

You will want a second and maybe a third person as a backup in case the first DPOA is unavailable. 

Communicating with your DPOA

If your intended DPOA accepts the role, you should provide them with a copy of your Advance Directive for Healthcare in which you have designated them as DPOA and made clear what you want done medically if you are unable to make decisions for yourself. The conversation should go beyond just the specifics of a ventilator, CPR, or a feeding tube, but should include the values and priorities that are important to you. They would include desire for control, level of pain you are willing to accept and much more. See the Compassion & Choices addenda – Values Worksheet and My Particular Wishes for a more complete list.