Guidance Concerning a Medical Power of Attorney

Catholic Candle note: Recently, Catholic Candle examined the permission the Church traditionally gives to a person who is in danger of death, to confess to a priest whom an uncompromising Catholic could not otherwise support (or confess to) because that priest is a compromiser, an apostate, or someone whom it is otherwise impermissible to support.  Find the article here: http://www.catholiccandle.org/2020/01/01/using-a-compromised-priest-when-dying/

Catholic Candle also addressed how uncompromising laymen can bury their dead in these times of great apostasy when an uncompromising priest is not available.  Find the article here: http://www.catholiccandle.org/2020/04/02/a-traditional-catholic-funeral-and-burial-when-there-is-no-uncompromising-priest-available/

Between this last confession (discussed in the first of those articles) and the burial (discussed in the second article), is the crucial moment of death.  We gave recommendations how to assist at a person’s death, based on the experience of some of the Catholic Candle Team, who recently assisted at the deaths of two uncompromising Traditional Catholics.  Find the article here: http://www.catholiccandle.org/2020/06/01/how-to-assist-a-person-in-dying-a-holy-death/

Also, in our last days of life, we must continue to give sufficient care to sustain our life – even as it is waning – and must not yield to the culture of death, which promotes euthanasia.  Therefore, we examined the minimum care we are obliged to provide to sustain our life even when we are dying.  Find the article here: http://www.catholiccandle.org/2020/07/01/use-of-ordinary-care-even-as-we-are-dying/

Again, because we live in a culture of death, part of our using sufficient care to sustain our life – even as it is waning – we must never acquiesce in being murdered by having our vital organs removed to be “donated” to another person.  Further, we must never accept the “donation” of a vital organ from someone else, as we would then become complicit in his murder.  Therefore, we examined the evil of such murder by the “donation” of a vital organ.  Find the article here: http://www.catholiccandle.org/2020/08/01/our-duty-not-to-donate-or-accept-donated-vital-bodily-organs/

Finally, it is sometimes advisable to appoint a wise and virtuous person to make decisions concerning our medical treatment when we cannot do so ourselves at some future time.  This goal is accomplished in many jurisdictions through a document called a Power of Attorney for Healthcare, or a Medical Power of Attorney.  Below, we examine this type of document and offer guidance (which would apply in many jurisdictions) based on the past experience of some of the Catholic Candle Team.

We recommend that you save all of these articles for future reference and use.

 


What is a Medical Power of Attorney?

Granting a “power of attorney” simply means giving a person the legal authority to act for you in certain matters.  In other words, granting a “power of attorney” simply means making a person your agent.  It does not refer to the person being a licensed attorney for the practice of law.  A Power of Attorney for Healthcare (also known as a Medical Power of Attorney) is a document through which you grant to your agent the legal authority to make medical decisions for you, when you cannot do so for yourself.


Why should you grant someone a Medical Power of Attorney?

Living, as we do, in a pagan world, we are surrounded by people urging us to make sinful decisions.  But we have a non-delegable duty to resist evil pressures and to do our best to make correct Catholic decisions.[1]  To help us make those Catholic decisions, we must have recourse to prayer, to study/research, and to advice from wise and virtuous persons.

Some of those Catholic decisions concern our medical treatment.  Further, it is foreseeable that the time might come when we cannot make medical decisions for ourselves because we are delirious, in a coma, or are otherwise unable to make them.  Therefore, it is prudent to provide for that possibility now by deciding who could best make the correct Catholic decisions for us then, in the event we cannot do so.

Below, we provide a draft Power of Attorney for Healthcare document.  This draft might need to be revised based on the laws of your particular jurisdiction. 

However, first let’s consider the type of person you should select for this important responsibility of holding your power of attorney for your medical treatment.


Selecting an agent to hold this medical power of attorney

You should select carefully the person to whom you give a medical power of attorney.  This person should be:

1.    Willing;

2.    Available;

3.    Sufficiently instructed in the Catholic principles which must be applied to your condition;

4.    Sufficiently intelligent to understand your condition;

5.    Decisive enough to make a decision without unreasonable delay; and

 

6.    Strong and steadfast in the face of opposition.

Below, we discuss each of these important conditions needed to make a person a suitable agent to hold your medical power of attorney.

1.   Your agent should be willing

Depending upon your future medical situation, it might be a substantial burden on a person to be responsible for making your medical decisions.  Therefore, common courtesy demands that you do not impose this burden on someone without first asking his permission.

Further, you will get better, more diligent decisions from a person if he has voluntarily accepted the responsibility for making your medical decisions and is willing to do it (if/when you cannot make the decisions).

2.   Your agent should be available

Even if a person is very willing to help you and accepts the responsibility for making your medical decisions if/when necessary, he would be a poor choice as your agent if it were foreseeable that he would likely not be reachable when urgent medical decisions must be made.

With the ubiquity of cell phones, this is usually not a problem.  However, if a person is foreseeably often unreachable, that would make him a poor choice as your medical agent.

A person who is in your area is preferable to a person who would need to make decisions without being able to actually assess your condition in person and meet in person with your doctors and other caregivers, when necessary.

For whatever agent you do choose, place all of his contact information (i.e., all ways to reach him) right into the form you use to grant him the power of attorney to make your healthcare decisions.  In this way, every caregiver who has a copy of your medical power of attorney would also have all of your agent’s contact information.

Because the future comes with many uncertainties, it is possible that your agent will not be available despite your best-laid plans.  Therefore, it is prudent that your medical power of attorney document would designate an alternate agent who would act in the event that your first agent is unavailable.

3.   Your agent must be sufficiently instructed in the Catholic principles which must be applied to your condition

Even if a person is willing and available, he would be a poor choice to act as your agent if he does not understand the Catholic principles controlling the medical decisions which must be made.  To take two examples:

  Your agent must understand that so-called “brain death” is not real death[2] and that he has a continued duty to take all reasonable measures to preserve your life and health even if the hospital declares that you are dead (meaning that you are so-called “brain dead”).

&#10070  Your agent must understand that the assertion that your life lacks “dignity” is not a basis for failing to sustain your life.


4.   Your agent must be sufficiently intelligent to understand your condition

However willing and available a person might be and however well-instructed in the relevant Catholic principles, he would be a poor choice as your agent if he cannot understand your medical condition and clear-headedly apply those Catholic principles to your medical condition. 

For example, Catholic principles require that a person be given sufficient fluids (and not be killed by dehydration).  However, if a patient’s organs have shut down and the patient is internally drowning in his own fluids because his body can no longer expel those fluids even with the aid of diuretics, then your agent should understand that the requirement of giving the patient hydration no longer applies (because it will no longer help sustain his life).

 

5.   Your agent must be sufficiently decisive so that he can make a timely decision

However willing and available a person might be and however sufficient his understanding, a person would be a poor choice as your agent if he was not able to make a reasonably prompt decision when necessary – even when the consequences of that decision are grave. 

A crucial decision should not be made through inaction and so your agent must be capable of being decisive when necessary.

6.   Your agent must be strong and steadfast in the face of opposition

However well a person might otherwise fit the requirements to be a good agent to hold your medical power of attorney, he would be a poor choice if he is not strong enough to remain steadfast in the face of opposition from medical personnel and emotional relatives.

Hospitals and doctors sometimes apply tremendous pressure on a decisionmaker if he seeks to prolong a patient’s life.  They might declare they refuse to provide the additional treatment – waiting to see how your agent will react to that declaration. 

Or, the caregivers might selectively disclose information to your agent, seeking to steer him into the medical decision they wish him to make.  This situation might require unusual tenacity in your agent to investigate and to insist upon treatment which would be in your best interests.

In extreme situations, to protect your life or welfare, your agent must be willing to threaten to hire an attorney and file a lawsuit to ensure your medical care or to prevent you from being murdered.  This lawsuit could either be you seeking a judge’s order to restrain medical caregivers from harming you,[3] or you threatening to hold them personally liable for medical malpractice.

Similarly, your medical agent must be strong enough to withstand the opposition of emotional family members who cry and plead: “How can you be so cruel and make Mom suffer?”, or relatives who shout or say: “Let Dad die with dignity”.

How not to choose a medical agent

Do not choose as your medical agent an unsuitable person because that person would have hurt feelings if he were not chosen.  Similarly, do not choose an unsuitable agent because of love or friendship.  The selection of your agent can literally be a matter of life and death for you.  Hurt feelings or emotional attachment should not be a consideration in the selection.

Generally, it is not a good idea to select a group, e.g., all of your adult children, to jointly make decisions concerning your medical treatment.  “Committees” are inefficient decisionmakers.  Further, sometimes medical decisions must be made quickly.  The more decision makers there are, the larger the potential delays in both successfully contacting the group and in their reaching a consensus decision.

Generally, a single decisionmaker is best.  However, if multiple decisionmakers are used, an even number of decisionmakers is a bad choice unless there is provision for breaking a deadlock (a tie) if there is a disagreement.  Although an even number of agents is generally a bad idea, it is a good idea to have a single agent with provision for an alternate agent if the first agent is unavailable.

We recommend that your medical power of attorney document has features similar to this draft form:


                   
Draft durable power of attorney for health care

I, [name], residing at [address and other contact information], hereby appoint my close friend, [name and all contact information], as my attorney in fact (“Agent”) to act for me and in my name, in any way I could act in person, to make all decisions for me concerning my personal care, medical treatment, hospitalization, and health care. 

If at any time and for any reason [insert agent’s name here] is unable or unwilling to act as my Agent, then I hereby appoint [alternate agent and all contact information here], as the then-successor Agent.

The powers I grant to my Agents do not include the power to direct or consent to withholding food or nutrition, water or hydration, oxygen, IVs, or common medicines such as antibiotics, which might be necessary or helpful for my well-being or for sustaining my life.  The powers I grant to my Agents do not include authorizing cremation or donating any of my organs to anyone, for any purpose.  My Agents shall have the same access to my medical records that I have, including the right to disclose the contents to others.

My Agents shall also have full power to authorize an autopsy and full responsibility for selecting the funeral home and choosing the “hard goods” (casket, etc.) and services related to my funeral, to be paid for through my [identify will or trust here].  I wish to be buried in the grave plot [information here concerning the cemetery, plot number, etc.].

I designate my Agent to have all authority to make all decisions concerning the religious aspects of my funeral and burial, including selecting the priest, if any, for the funeral and burial, etc.  All expenses related to these decisions shall be paid by my [identify will or trust].

I ask that at no time, including at my wake, that I be eulogized or that it be suggested that my soul is known to be already in heaven.  I would like the five Sorrowful Mysteries of the Rosary to be recited at my wake (not the Glorious Mysteries).     

If a guardian of my person is to be appointed, I nominate my Agents acting under this power of attorney as such guardian, to serve without bond or security.

I understand the full significance of the broad powers I am granting to my Agent in this instrument.  This is a durable power of attorney which has no expiration date and is not rendered null or void by the passage of time or by my disability or my declining health.

 

Date:                                  Signed:   _________________________________________                  

                                   

The principal has read this instrument and signed it in my presence.

 

Witness:                              Residing at:  _____________________________________                          

 

Witness:                              Residing at:                                 ____________________

 

Specimen signature of my Agents              I certify that the signatures of my Agents are correct.

 

______________________________            _______________________________________                                                         

[1st Agent’s name typed here]                   [name of person granting power of attorney]

 

______________________________            _______________________________________                                                         

[2nd Agent’s name typed here]                  [name of person granting power of attorney]

Note: Obviously, this medical power of attorney should be modified according to your circumstances.  For example, this form should be modified to reflect your prepayment of your funeral expenses, if you have prepaid them.

Final consideration – what should I do with my Medical Power of Attorney after it is signed?

After your medical power of attorney is completed and signed, do not merely put it with your important papers or in a safety deposit box at a bank (although those are good places to leave a copy). 

Broadly disseminate your power of attorney to your family, friends, and caregivers – because when you have a medical emergency, they are going to be focused on your treatment, not focused on searching through your important papers to find your medical power of attorney.

Give your power of attorney to your hospital, your family doctor, your specialist doctors, your oral surgeon, your assisted living facility, your medical rehabilitation facility, etc.  The more broadly you spread your power of attorney, the more likely it will be that it will be known and used in an emergency because more people will know about it and have access to it. 


Conclusion

In the culture of death in which we live, it is foreseeable that we might be harmed (or killed) by our treatment not corresponding to the requirements of Catholic principles.  A medical power of attorney is a tool to help us to prevent potential harm and to obtain help making those decisions when we are unable to do so.

It is prudent to provide now for a capable and virtuous agent who can make treatment decisions for us, according to Catholic principles, at that future time. 

We recommend that you give your agent a copy of the articles in this series on end-of-life matters.