Post 19: Bringing Up Medical Power of Attorney (MPOA) Doesn't Have to Be Awkward - A Six Step Guide
Updated: Jul 12
"My daughter got so scared when I brought home a blank medical power of attorney form that she told me I should consider switching doctors. What does it mean? Is it really that bad?"
As a palliative care physician (read Post 1: What Exactly Does a Palliative Care Specialist Do?), I offered to explain to Mr. H what an MPOA [also called a medical durable power of attorney (MDPOA)] is [read Post 4: Eleven Common Myths About the Medical Power of Attorney (MPOA)] and offered tips on how he could discuss it with his daughter.
"Sure! Anything would help!"
1. Blame the doctor for giving you homework.
"The doctor told me to talk about the medical power of attorney with my family because it's a standard part of my medical care. The doctor said she talks about this with all of her patients at least once a year. She said I could talk about this with you anytime - she said hopefully before my follow up visit so she could answer any questions that come up."
Sometimes, it is not a visit with a physician and rather a talk with a friend or an article that a person reads or events that occur that causes a person to want to bring up the MPOA question.
"Hank was telling me his doctor gave him an assignment. He said he had to talk to his family about a medical power of attorney, and he said it was a good talk. So I wanted to talk about it with you too."
"Do you remember when the paramedics kept asking if Grandma had a medical power of attorney? I don't want that chaos if anything were to happen to me - or to you! - so I want us to get it on paper."
2. Use ordinary scenarios.
"I had to answer a question. 'If I were delirious from a bad infection or unconscious from a stroke or car accident, whom would I trust to talk to the doctors about everything going on with my body and make decisions about how my body should be treated until my mind cleared up again?' Well, of course, I told the doctor it would be you. You already do that anyway."
3. Share what is most important to you for quality of life.
"The doctor said that my MPOA should be someone who can stand up to the medical teams and ask questions if they had to, to stick up for me and for my quality of life. So I just wanted to let you know that being able to get around on my own is really important to me. Even if I have to use a cane, walker, scooter, wheelchair - I don't want to have to be dependent on anyone else to get to the bathroom. You'll be able to keep that in mind, right, if I ever needed you to stick up for me?"
Share with your potential medical decision maker what is most important to you for quality of life, and ask them if they would be able to make decisions to support what is most important to you. If not, you may both realize that someone else should be your MPOA. After all, they might have to stand up to both healthcare providers and to strongly opinionated family members and friends.
4. Explain that the MPOA form protects the person you choose as much as it protects you.
"After I fill out the MPOA form, apparently the most important person to have a copy would be you! That way, if a paramedic, emergency room doctor, ICU doctor, internist, or surgeon ever questions you and asks what gives you the right to speak for me, you can hold up your copy and say, 'This! This gives me the right.'"
MPOA forms in every state look different, though they all usually ask for both a primary MPOA and up to two alternate "back up" MPOAs in case the first one is not reachable. Every MPOA listed, both primary and alternates if there are any, should keep a copy in an easy to find place. It would be one less item to search for during a medical emergency.
Even better would be for every MPOA to keep multiple copies. "I gave my copy to the specialist and never got it back" is a comment commonly heard from medical decision makers.
5. Discuss with family, friends, and any person who keeps in touch with you whom you are going to name as MPOA.
"The doctor said this is my decision and technically I don't have to talk to anyone but you about it because I already know that I'm picking you. But she said it'd be a good idea to tell everyone else so that everyone has their say now and so that they're not going on and on about why I didn't pick them and hassling you about it during an emergency."
Whom a person chooses as MPOA is not representative of whom they love most.
This would be the time to remind loved ones that you want as your decision maker someone who is easily available by phone day and night, who will ask the physicians questions, and who will be able to stand up for what is most important to you without giving in to what other family members say.
6. Treat your MPOA like you would your car insurance.
"Every year, like maybe when I do taxes, I'm supposed to review my MPOA form. It could just take a minute. I need to make sure I can locate it. I need to make sure my MPOA and all my back up MPOAs have copies. The doctor said since we hardly ever need it, the MPOA form gets easily misplaced or lost. She said hopefully we'll never need to use it, like car insurance, but it's something we want to have if we need it."
"Mr. H, what do you think? Do you now feel more comfortable talking about the MPOA?'
"Now that you've explained it, I don't know why we don't all fill out an MPOA form! It sounds like it could get messy if you didn't fill one out."
"Yes, sometimes it does get messy [read Post 14: A Medical Emergency and No Medical Power of Attorney (MPOA)! - Two Everyday Scenarios]. I'm glad you realize how important having an MPOA can be."
"Yeah, and I'm definitely going to talk about the medical power of attorney form with my daughter. She'll probably feel relieved after I explain to her what this is all about. In fact, I'm going to tell her to complete one too!"