Durable Power of Attorney:Who Will Make Life or Death Decisions?

University of Iowa Health Science Relations Peer Review Status: Internally Peer Reviewed Many people have heard of a Living Will, a document that explains to your family, friends, doctor, and the courts what you do and do not want done to prolong your life.

Fewer people have heard of the Durable Power of Attorney for Health Care. Durable Power of Attorney for Health Care lets you choose a person, or persons, who can legally make health care decisions for you if you become unable to make those decisions and speak for yourself," says Gretchen Schmuch, a family practice social worker in the University of Iowa College of Medicine.

"One of the most difficult things about choosing your legal decision-maker is discussing end-of-life matters," Schmuch says. Questions you should ask yourself include:

1. Whom do I want to make decisions about my health care?

2. Is quality of life more important than quantity of life?

3. How important is physical and/or mental functioning in decisions to accept, refuse, or limit medical treatment?

4. What are my spiritual beliefs and how do they fit with my choices?

5. Are food and water basic human rights, regardless of delivery (tube, mouth, or vein)? A majority of Americans say they want to participate in their health care decision-making until they die, but approximately 15 percent have completed a Durable Power of Attorney.

If asked, most people have a general idea of what they want, Schmuch says. It is important for people to discuss their values, health care beliefs, and wishes with their families and their doctors. "But doctors often wait for the patient to bring the subject up, and patients wait for the doctor. So we have a lack of communication, with no decisions being made until a crisis arises,"

Schmuch says. During a crisis, such as when an elderly parent dies but is revived or a spouse has a heart attack and is in a coma, a decision as crucial as what treatment the patient would want makes a difficult situation more painful. If a patient does not have a Durable Power of Attorney, decisions must still be made.

"In Iowa if no one has been designated, the decision-making authority passes--in order--to guardian, spouse, majority of adult children, parents, and sibling. In a few cases the matter would be decided by a hospital board or the courts. "It's so important to talk with each other to determine what should be done,"

Schmuch says. "Living wills are valuable tools, but no document can provide answers in all situations. Selecting someone who understands and can advocate for your health care directives and giving him/her over the authority to make decisions for you will put you at ease now," says Schmuch. "And your family and friends will not have to worry about who will make the decision in the future." If you have questions about Durable Power of Attorney and Living Wills, talk to your doctor.