Case Study 30 : DURABLE POWER OF ATTORNEY
Challenges
An 81-year old male diagnosed with COPD and chronic bronchial asthma was admitted due to difficulty in breathing. Two hours prior to admission, the patient suffered sudden difficulty in breathing and became cyanotic, but medications offered sufficient relief. In view of his deteriorating condition and age, the doctors advise the family to assist him in drafting a Durable Power of Attorney.
Question
What is a “Durable Power of Attorney”?
Solutions
A Durable Power of Attorney for Health Care (or “Health Care Proxy”) is another form of advance directive – a legal document written by the patient, with or without the assistance of an attorney, that takes effect when the patient becomes incompetent. It assigns a specific individual (the “proxy”, “agent” or “surrogate”) to make medical decisions on behalf of the patient (the “principal”) when the latter becomes unable to do so. They are to be reviewed periodically by the patient, with the latest revisions distributed to all concerned. Advance directives facilitate decision-making for the incompetent patient.
Assigning Durable Power of Attorney seems preferable to an Advance Medical Directive (discussed in another issue of Bioethics Bits) because the proxy is personally chosen by the patient. The proxy should be of good moral character, familiar with the patient’s beliefs and principles, with the wisdom to make sound decisions under stressful circumstances, and of course, should probably outlive the patient. A certain knowledge of bioethical principles, or at least a willingness to learn them, is preferable. One should also designate alternate agents in case the first is unable to act.
The agent decides in light of what the patient would choose if able to do so. If there is an Advance Medical Directive, it should be followed. Note, however, that acting in the best interests of the patient sometimes means ignoring instructions that are obviously unwarranted or immoral. (Reference: National Catholic Bioethics Center, A Catholic Guide to End-of-Life Decisions, 1997.)
