Agent Is Given the Final Authority
Evelyn is an 84-year-old widow. She has a $2 million estate. She is meeting with her lawyer to discuss estate planning. He has told her about something called a durable power of attorney for health care--DPAHC. It allows her, she is told, to appoint someone to make health-care decisions on her behalf, if she is unable to do so.
I don’t want to be hooked up to “those machines,” she says, and decides her 74-year-old friend Ida should be appointed her agent, because “she’ll know what I want.”
Evelyn is not real. She is a hypothetical character created by Gregory Millikan, a Pasadena lawyer, for a role-playing session held last week as part of a forum at the Los Angeles County Medical Assn. The program, “The Power to Decide: Decisions About Life-Sustaining Health Care,” brought doctors, lawyers and other health-care professionals together to discuss the DPAHC.
The DPAHC allows you to designate someone as your surrogate decision-maker for health-care decisions if you are incapable of making them, explained Judith Daar, of the UCLA Law School. To encourage compliance, doctors who follow the instructions of the agent are granted immunity from criminal prosecution, civil liability or professional discipline for treatment they provide or withhold.
The document can help doctors decide whose instructions to follow, especially in complicated family situations. For example, Dr. Kenneth Landis told of a 60-year-old man with two ex-wives, children from his first marriage, a brother, a sister and living parents. In such situations, doctors are left to rely on consensus, which means that if one or two people object, the doctor will continue all forms of treatment. Landis noted that there are also complications with AIDS patients, whose parents and lovers may disagree about treatment.
Landis cited several advantages to the DPAHC: It provides legal immunity to the health-care providers; it is available to all competent adults; it allows a range of choices, and it gives a person the opportunity to make personal preferences about specific treatment, such as the use of chemotherapy. It also allows for decisions about organ and tissue donations.
The California Medical Assn. has published a standard form, with eight pages of instructions. Most of the speakers recommended using this form, because it is widely recognized by the medical community. For a copy of the CMA form, send $1.60 to Sutter Publications, P.O. Box 7690, San Francisco, Calif. 94120, telephone (415) 882-5175.
“I personally can’t imagine why everyone in the world hasn’t executed one,” said Griffith Thomas, a lawyer who also has a degree in medicine and specializes in legal-medical issues. It is difficult to know how many doctors and patients are using the form in practice, but Thomas recently canvassed lawyers across the state and could not find one instance in which a lawsuit had been filed contesting a DPAHC.
If you decide to sign a DPAHC, be sure that you discuss it with your physician and family members, and that they know where it is--and what it is. Thomas recently had surgery himself and discovered that his surgeon had never seen one of these forms. And when he awoke from surgery, he learned that the form was not on his chart, where it would help doctors on duty to know who had decision-making authority. Someone had left it in the hospital’s office.
