Medical Power of Attorney

What You Need to Know

By completing the Medical Power of Attorney form, you can appoint someone you know and trust to be your agent. Your agent can make health care decisions for you if you are unable to make them for yourself. This form is an important legal document. Before signing it, be sure you understand the following facts and terms:

Agent

Anyone can be your agent except:

• A person under 18 years of age, unless emancipated
• Your health care provider
• An employee of your health care provider, unless that employee is related to you
• Your residential care provider (for example, nursing home or hospice)
• An employee of your residential care provider, unless that employee is related to you

Tell the person you appoint that you want him/her to be your health care agent. Give him/her a signed copy of the Medical Power of Attorney form.

Authority of Agent

Your agent makes decisions only when you are not able to make them. Unless you state otherwise, he/she has the same authority to make health care decisions as you have now. Your agent may consent, refuse to consent, or withdraw consent to medical treatment. He/she may make decisions about continuing or stopping life support treatment.

A section on the Medical Power of Attorney form is called "Limitations on the Decision-Making Authority of My Agent Are As Follows." You can leave this section blank. However, your agent must follow any instructions you leave for him/her.

Examples of limitations you might choose include:

• Provide comfortable, pain-free care
• Do not keep me alive if I am going to remain in a coma
• Use (or do not use) a feeding tube

Even after you have signed the Medical Power of Attorney form, you have the right to make health care decisions for yourself as long as you are able to do so. Treatment cannot be given to you or stopped over your objection. You have the right to take back the authority granted to your agent, at any time, either orally or in writing. To do so, tell your agent or your health care provider that you choose to take back the agent's power. You can do this regardless of your mental capacity or competence.

Witnesses

Your Medical Power of Attorney form is valid only when you sign it in the presence of at least two qualified witnesses. The following persons may not act as witnesses:

• The person you have designated as your agent
• A person related to you by blood or marriage
• A person entitled to any part of your estate after your death under a will or codicil executed by you or by the operation of law
• Your attending physician
• An employee of your attending physician
• An employee of a health care facility in which you are a patient if the employee is providing direct patient care to you or is an officer, director, partner, or business office employee of the health care facility or of any parent organization of the health care facility
• A person who, at the same time this Power of Attorney is executed, has a claim against any part of your estate after your death