If you have ever considered insurance for anything (cell phone, cruise trip, concert tickets, car, medical, disability, or life), you know that the purpose of insurance is to give us peace of mind for "just in case." That is the purpose of naming a medical power of attorney (MPOA)!
The purpose of an MPOA is to ensure that if a person were ever unconscious from a car accident or loopy in reaction to anesthesia that they have someone they trust to look out for them. The MPOA acts as a person's voice and makes healthcare decisions until the person is alert and aware enough to make decisions for themselves (Read Post 10: Four Simple Questions to Determine if a Person is of Sound Mind).
Unlike other insurances, completing an MPOA document is usually at no cost! So why would a person hesitate in naming an MPOA, that is completing an MPOA document?
Myth #1 - If I name an MPOA, I give up the right to make healthcare decisions for myself.
"I'm still of sound mind! I'm not signing that!"
When does a person use insurance? When something unexpected and bad happens. Insurance is otherwise on "standby" as a person lives their day to day life. The same concept applies with the MPOA.
A person makes their own healthcare decisions until something unexpected and bad happens and the person is not mentally able to understand what is going on and make decisions.
It might be temporary. "I broke my leg falling off the ladder and I'm in so much pain, I can't focus on what the doctors are saying! You talk to them."
It might be long term. "Ever since she underwent whole brain radiation, she's had a hard time understanding and remembering things. That was two years ago. I talk to the doctors for her and break it down for her without the doctors around. She gives me her input, and we make a decision together."
The MPOA only has the right to make healthcare decisions, temporarily or long term, when the person is unable to fully understand what is going on or voice decisions themselves. When the person regains capacity, the ability to understand the healthcare question and make decisions consistent with their values, then the MPOA is again placed on standby and the person makes their own healthcare decisions.
Myth #2 - The MPOA is a reflection of the person I love the most or the person I trust the most.
"I haven't filled one out because I don't want my children thinking I picked one over the other."
I remind my patients that the MPOA will not necessarily be their favorite child or best friend. It is the person whom they trust to make healthcare decisions the way they themselves would when surrounded by vocal family members in emotionally charged or emergency situations. "Not my daughter. She loves me so much. I told my daughter once I would never want to be hooked up to a machine, and she told me she would never be able to let me go."
The MPOA is the person who will not make healthcare decisions based on their own fears, guilt, shame, anger, or grief. Personal experiences and religious beliefs should not drive the MPOA's healthcare decision making.
"I know I'll need transfusions with this chemotherapy. My parents are Jehovah's Witnesses, but I am not. They have been by my side this whole time, and I trust them completely. I just don't know what would happen if I needed transfusions, and they don't either. So I asked my best friend to be my MPOA."
Myth #3 - The MPOA will have access to my finances, bank accounts, properties, and will.
"I signed a power of attorney form. So if anything happens to me, they can make all the decisions."
A medical power of attorney (MPOA) document is different and separate from a durable power of attorney (POA), also called a financial power of attorney, document. The MPOA may be the same person or a different person from the financial POA.
An MPOA document gives the MPOA the power to make healthcare decisions only. It gives no power for financial decision making.
A durable, or financial, POA document gives the POA the power to make financial decisions only. It gives no power for healthcare decision making.
If a person wanted to name both an MPOA and a durable/financial POA, they would complete the two separate documents. They can name one person on both forms, or they can name different people on the two forms.
"My dad made me the MPOA because he lives with me and my family, and we take care of him. He knows I'll honor his wishes. He made my brother the financial POA because my brother's an accountant and he trusts my brother to make money and investment decisions the way he would."
Myth #4 - The MPOA has to be a family member.
"Never married, never had kids. I got two nephews somewhere. I don't think they even care if I'm alive. Only person I talk to every week is my bartender. And yeah, we talked about the Terry Schiavo case."
If your bartender is the person you trust most to make healthcare decisions the way you would, then your bartender should be your MPOA (after you ask him if he would be willing).
The MPOA does not have to be a family, relative, or friend. The MPOA is whomever a person is willing to communicate their most important values and priorities. The MPOA is whomever the person trusts to make all healthcare decisions on their behalf based on those values and priorities. The MPOA is whomever is willing to take on this responsibility whenever needed.
Some states do establish specific instructions on who cannot be named an MPOA to protect against potential conflicts of interest. An example for some states would be that a person's healthcare provider may not also act as the person's MPOA. It is important to check your state's instructions to determine if there are specific limits on who can be named an MPOA.
Myth #5 - The MPOA has to live nearby.
"I would name my daughter, but she moved to California last year."
As long as a person is at least 18 years old, easily reachable by phone, willing to act as a surrogate decision maker (and does not meet a particular state's exclusion criteria on who is allowed to be named an MPOA), they can be named an MPOA.
"My son lives in Hong Kong, but we talk every other day. He knows what's going on. You can reach him anytime. He's my MPOA."
Myth #6 - The family makes decisions together, so everyone should be named co-MPOAs.
"Can I name my husband and my four children? We make all decisions together as a family anyway."
The MPOA should be the one person a person trusts most to act as their voice when talking to medical providers. They would be the spokesperson with whom multiple specialists would communicate.
The MPOA can then relay medical information to other family members and obtain the advice of family, friends, and other healthcare providers such as the person's primary care physician (PCP), if they so desired. The MPOA can choose to make each healthcare decision a group decision, which the MPOA would then relay back to the multiple specialists as the spokesperson. If there were disagreements within the family, the MPOA would make the final decision.
The existence of more than one MPOA, that is co-MPOAs, causes significant medical care inefficiencies and confusion, especially when multiple specialists and rotating healthcare providers are involved.
"We need to get consent from both the daughter and the son - they're both MPOAs - before moving forward with this surgery, but we cannot reach the son." "The primary team said they already spoke to the son about how her kidneys are doing. The daughter is available now; let's talk to her about the liver MRI results."
If co-MPOAs disagree, almost always the default "keep the person alive no matter the future quality of life" course will be taken.
I recommend to my patients that instead of naming co-MPOAs that they list alternate, or "backup," MPOAs in case the primary MPOA is not reachable during an emergency.
"I want my husband to be my MPOA. If they couldn't reach him or something happened to him, then I would want the doctors to talk to my son. He's my backup MPOA. If they couldn't reach him, then my daughter would be my second backup MPOA."
Myth #7 - The MPOA will be in charge of my memorial service/ funeral service/ burial/ cremation/ medical debt after I die.
"I have so much money I owe the hospital. I cannot name my son because I don't want to burden him with my debt."
The MPOA only has the power to make healthcare decisions on behalf of another person while the person is alive. The MPOA does not have the power to make decisions about after death care, such as the memorial service, burial, or cremation. The MPOA has no decision making power regarding the will nor inheritance, and they do not inherit the medical debt.
Of course, a mom may name her son as her MPOA. And then she could tell her son, "I don't want a fancy memorial service. Save your money! I want to be cremated...and don't keep me cooped up in a jar!" The son, as her son, could choose to honor his mom's after death wishes or not.
Myth #8 - The person I want as my MPOA must be present when I sign the MPOA document.
"My son will be here for Thanksgiving. That's the soonest he can sign."
Only the person naming an MPOA signs and dates the MPOA document.
No one else has to be present, except perhaps witnesses or a notary depending on the state.
For example, Colorado's medical durable power of attorney (MDPOA) - same thing as an MPOA - document does not require witnesses nor notary. Texas's MPOA document requires either a notary or two witnesses. Some states place restrictions on who can act as a witness, so it is important to read the instructions for your particular state.
Myth #9 - I have to update the MPOA document every year.
"This MPOA document is pretty old. Do I need to complete an updated one?"
The MPOA document remains legally valid for as long as the person is alive. The person does not have to complete a new MPOA document every year. If they named their grandson as MPOA eleven years ago, and they wish to keep their grandson as MPOA, then the document remains legally valid eleven years later.
An MPOA document becomes invalid if a spouse was named, and the person is now divorced from that ex-spouse.
A person may change their minds about whom they would want as their MPOA at any time: their wife is diagnosed with dementia; their son has started drinking again; their daughter is herself dealing with advanced breast cancer.
If a person changes their mind about whom they would want as their MPOA, they would complete a new MPOA document. The most recently dated MPOA document then becomes the legally valid document.
Myth #10 - I need an attorney to complete an MPOA document.
"I can't afford an attorney for that document."
An MPOA document can be printed from each state's public health website (each website goes by a different name), and many physicians and hospitals have available MPOA documents.
For some states, a person could complete, sign, and date an MPOA document on the spot, and that MPOA document would then be legally valid. For other states, a person must sign and date the MPOA document in the presence of a notary or one to two witnesses before the document is legally valid. An attorney, or lawyer, is not necessary to complete an MPOA document.
Myth #11 - I have to keep the MPOA document in a secure, safe place.
"I keep all my important documents in a safe deposit box."
Distribute copies of your MPOA document to everyone! Your listed primary and backup MPOAs, your family, your PCP, and your specialists should have copies. Keep extra copies in the house in case paramedics are called. Bring copies with you if you have to go to the hospital.
The copies of an MPOA document will be honored just as the original.
When a daughter is being questioned if she has the right to make healthcare decisions for her father, she pulls out her copy of her father's MPOA document and shows the paramedics/ emergency room (ER) physicians/ hospitalist/ intensive care unit (ICU) team/ surgeons her name on her father's MPOA document.
Everyone named as primary or alternate/backup MPOA should keep a copy because the
MPOA document serves as both your insurance (that someone you trust will be weighing in on how your body should be treated) and their protection (in case a healthcare provider questions if they have the right to weigh in).
A Final Note
It can be frustrating that different states in the United States have different names for the same concept. MPOA is also known as medical durable power of attorney (MDPOA) or durable power of attorney for healthcare, depending on the state.
Also, the document to complete the MPOA/ MDPOA/ durable power of attorney for healthcare looks different for each state! Usually states honor the MPOA documents of other states, but this should be confirmed any time a person moves from one state to another state.
An MPOA is insurance that a person you trust will make medical decisions the way you yourself would make if you could talk and be alert. They may have to act as your voice for two hours or two decades. When you are at your most vulnerable, this is the person who will fight for what is most important to you [Read Post 14: A Medical Emergency with No Medical Power of Attorney (MPOA)! - Two Everyday Scenarios].
Why would a person hesitate in naming an MPOA (read Post 19: Bringing Up Medical Power of Attorney (MPOA) Doesn't Have to Be Awkward - A Six Step Guide)?