A Dying Dilemma
The majority of us haven't set up a health care power of attorney, even though it's one of the most important legal papers we'll ever sign.
It's funny how you only hear about how crucial it is to choose a health care power of attorney (POA) when life turns ugly. But more and more, those who understand the importance of advance directives are attempting to change the attitudes of those us who think end-of-life issues "won't happen to me."
A year ago last fall, for instance, HospiceCare medical director Carl Weston began mentoring 150 new students at the University of Wisconsin Medical School.
"For the class of 2007, I gave them a survey asking them about their health habits and if they had a living will or medical power of attorney," Weston says. "Fewer than ten students had one."
In his 40 years as an internist, Weston says he saw too many problems associated with patients who had no POAs. More doctors, he says, should be setting an example. "I bribed them with ice cream. I told them if they got POAs by the end of their first year in medical school, I would treat them to Babcock Hall ice cream."
So, here are a few things you should know about securing your or your loved one's own health care or medical power of attorney. Study up, and then treat yourself to an ice cream cone.
Coalitions are forming to develop strategies and training for advanced care. Melanie Ramey, attorney and executive director of HOPE of Wisconsin, jump-started Wisconsin's 14 end-of-life coalitions into forming the Advanced Care Planning Project. "We need to get more people trained and develop a systematic approach throughout the state," she says.
Locally, HospiceCare has begun POA training for members of health care, clergy and others. "There's a lot of work here to do to motivate more people to have power of attorneys, and we believe it should start with us," says HospiceCare president and CEO Susan Phillips. The initiative is modeled after a La Crosse end-of-life coalition that turned around that community's advance directive numbers from some 15 percent of residents with POAs to between 85 and 90 percent. "We want to greatly increase the number of POAs in Dane County, and we're optimistic it can happen now that we're putting the right tools in place."
Wisconsin law protects the individual. "You can't put incapacitated people in a facility like a nursing home without their consent -- unless they've authorized an agent to make that decision under a health care POA," says Janice Bensky, an attorney with Stafford Rosenbaum, who specializes in estate planning and probate.
If you don't have a POA, your family and health care providers cannot act on your behalf. "People often don't realize the degree of heartache and expense that is passed on to family members when there is no POA in place," Bensky says. Without a POA, she explains, the family will have to go to court, ask a judge to appoint a guardian for the incapacitated person, and order a protective placement. "But the process can be lengthy -- it may take two or three months -- it can be costly, and it can add a tremendous amount of stress to an already difficult situation," Bensky says.
Physicians can't disclose medical information without a POA. With a POA in place, however, your authorized agent can communicate with medical personnel to help make informed decisions.
Talking to a doctor about a POA now can save headaches later. You may have specific health care questions he or she can help you address, and once you have a health care POA, make sure your doctor's office gets a copy to file away with your medical records.
More people are lumping major life decisions together. "The estate planning process," explains Bensky, "is a good time to specifically say what life-sustaining measures you want or don't want. You should do this when you have time to think about your wishes, not when you're panicked, going into surgery, and you're asked to sign a form at the hospital."
Establishing a POA is more than filling out a form. It starts with conversations with loved ones. And make sure the agent you choose signs off on the document -- and knows where you keep it.
The person you choose as your POA agent might not choose you. "Don't assume the person you ask to be your agent will automatically say yes," says HOPE of Wisconsin's Ramey. "Not everyone wants to take responsibility for someone else. You want someone who will be your advocate, so if the first person is reluctant, choose someone else."
Signing a POA doesn't have to reflect your final words on the subject. "Take the POA out and look at it yearly," Ramey advises, "like you would other documents such as wills and insurance. Your agent may have moved out of state or other things may have changed. You can change your POA, but the important thing is to put one in place when you're healthy."
Sharyn Alden is a contributing writer to Madison Magazine.