Handbook for Mortals : Questions and Answers About Advance Directives : Why do I need someone to speak for me?

Your doctors should always know who to turn to for decisions when you cannot decide for yourself. If you have no close family - or your family doesn't work together very well - it is important to figure out who should be your "voice," and to involve that person in treatment decisions all along throughout your illness.

You can write your decision into a "durable power of attorney" or "health care power of attorney." This gives another person authority to make decisions if you become unable to do so. These designations are considered "durable" because they remain in effect even if you become unable to make decisions for yourself. Most people appoint a close friend or family member. If you donít have anyone, a minister or lawyer may serve. Make sure the person you choose will support you in the way that you want, under-stands your treatment choices, and knows what you value.

Giving someone else this authority is often more important than writing down preferences. Naming an advocate makes it easier for your choices to be recognized and followed. Otherwise, you risk having decisions made contrary to your wishes or by people you would not have chosen. This predicament also burdens those who love you by forcing them to make decisions without any clear guidance. Remember that these documents are only in effect when persons actually lose decision-making ability, and not before. Many people fear that these documents will override spoken wishes if they still have decision-making abilities, but this is not the case.

Durable power of attorney forms do not give explicit guidance to the proxy about what decisions to make. Many states have developed forms that combine the intent of the durable power of attorney (to have an advocate) and the intent of the living will (to state your choices for treatment at the end of life). These combination forms will probably be more effective than either of the two used individually.

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Keywords: Advance care planning, durable power of attorney, DPOA
Handbook for Mortals book cover Copyright © 1999, 2006 by Joanne Lynn. This extract from the Handbook for Mortals by Joanne Lynn, M.D. and Joan Harrold, M.D. is used with permission. To learn more about improving care at the end of life visit the main web site for Americans for Better Care of the Dying.
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