Difference Between Health Care Surrogate and Power of Attorney

No matter your age, health or financial situation, it’s probably a good idea to appoint a medical power of attorney (MPOA) 1. With few exceptions, most people will go through at least one period of physical vulnerability in their lives. It may be decline at the end of your life because of old age, or it may be because of an unanticipated accident, temporary medical condition or because of a psychiatric condition. In any case, there may be a few hours, days, months or years when you are unable to make your own medical decisions. You can exert the most control by appointing an MPOA.

Decisions to Be Made

If you were to fall into a coma, would you want to be on a ventilator? For how long? Would you still want to be put on a ventilator if you had lost brain function? If you were put on a ventilator and had no brain function, would you want to be given antibiotics? Medical decisions can be overwhelming, but they need to be made and someone needs to take the responsibility to make them if you are unable.

Power of Attorney

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The medical power of attorney is appointed by you in a legal document to make medical decisions for you 1. In the document, you can specify when the person takes control and what kinds of decisions can be made. You can specify what kinds of medical intervention you want and under what circumstances. The MPOA may be guided by two documents: the “living will” (known in some places as “directive to physicians”), which states under which conditions your life can end due to withdrawal of medical interventions, and the “advance medical directive” (AMD), which indicates what course to take in specific medical circumstances. The MPOA makes medical decisions on your behalf, advising doctors at every step how they want your treatment to proceed.

Note that the MPOA does not give that person any influence over your finances or any other aspect of your life unless you so designate. The general POA is an entirely separate document, and the courts do not automatically assume that if you designate a medical POA that this person should have any control over your finances as well.

Health Care Surrogate

A health care surrogate (HCS) is appointed by the doctor or nurse if the doctor determines that you cannot make medical decisions yourself and there is no existing MPOA 2. That person may be a relative or friend. There are hierarchies of consideration, e.g. your spouse would likely be appointed before your adult child, but the doctor also considers the ability of the person to make decisions, the relationship level and the level of concern the person has. If you do not have suitable relatives or friends, the appointed health care surrogate may be unknown to you, someone from the hospital or an agency 2. In either case, the HCS is generally operating without the advance medical directives and will make decisions based on your “best interests,” but without the AMD to guide them, they are likely to have a personal bias or be influenced by the philosophies of the institution for which they work.

What You Can Control

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By appointing the MPOA, you will be able to select the general approach the person will take for your care. By filling out the advance medical directives, you can have direct influence over specific medical situations. You can add to the advance medical directives, if you choose, to cover situations that are special to you. If you decide not to appoint an MPOA, at least discuss your preferences in medical situations with your family and friends so if one of them is appointed health care surrogate, she will have an idea of your wishes 2.

What You Can’t Control

No matter how well you know the person you appoint as MPOA, you likely haven’t seen him in a similar situation, so his decisions may be different from what you imagined them to be. The MPOA also has the option of not accepting the responsibility, and passing it on to another person. Also, no matter how detailed your advance medical directives are, there will be situations that are not covered. In the end, you will have to trust that the person who makes the decisions for you will do his best and make decisions he believes are in your best interests.

Making it Legal

The forms for appointing a medical power of attorney can be found at any lawyer’s office, but also at the hospital 1. They are not difficult or expensive to fill out, but do require two witnesses (a notary public seal may be required) and should be copied and distributed among the people who might be involved in a medical situation.