Who makes the decision when the patient can’t? Power of attorney is important

Whether to “pull the plug” on a loved one could be the most difficult decision you’ll ever have to make—or that will ever be made for you—but having a conversation about such a situation ahead of time may make the decision somewhat clearer.

Attorney Will Halker of Christian Law Association faced the decision in 1995 after his 18-year-old son, Liberty, was in a car accident. But Will and Liberty had had “the conversation,” as one Christian physician calls it, about life-ending choices. Liberty told Will that if he were ever in a “vegetative state,” he wouldn’t want extraordinary measures to be taken to keep him alive.

It still wasn’t an easy decision. Liberty was in a coma and classified as “brain dead” by doctors.

Halker consulted four doctors, each of whom told him that he should remove Liberty from the respirator.

CLA, the law firm Halker works for, is the firm that would later try to save Terry Schiavo’s life. Schiavo was the 41-year-old woman who died in 2005 after her feeding tube was removed at her husband’s request. David Gibbs III of the CLA represented Schiavo’s parents in their effort to keep her alive.

In his son’s case, Halker agreed with the doctors and, taking Liberty’s expressed wishes into consideration, he allowed the respirator to be removed from his son, who died seven minutes later.

“I had a very clear understanding of what his wishes were, but nevertheless, I was very careful before I made the decision,” Halker says.

Having that conversation is vital, says Dr. Jack Bicket, a North Carolina physician, bioethicist, and member of the Christian Medical and Dental Association.

“There is significant stress, anxiety, guilt, even regret for the decision makers for patients,” Bicket says. “It’s not an easy position for a family member to be in. But it can be made more comfortable if you’ve had that conversation and have some documents to sort of guide you.”

Both Bicket and Halker stressed the value of going to an attorney or using an online service with legal forms to designate someone as a health care power of attorney (although they may have different titles in different states, such as “health care surrogate”). That generally gives a person the right and responsibility to make health care decisions for you if you become incapacitated. It’s important, though, to have such a document written properly and given to the appropriate people, such as family members, doctors and hospitals.

“[A health care power of attorney] is where someone presumably who knows you well, a family member or such, is named as your spokesperson if you’re unable to speak,” Bicket says.

You can even assign the power to two people, with a third assigned as a tiebreaker in the event of disagreements.

But it’s essential that the person or persons making the decisions for you have some idea of what you would want in different types of situations. And that can only happen if you’ve had such a conversation about it with them, no matter how difficult or unpleasant it may be.

Another option to prepare for a drastic medical situation is a “living will.” That document is a “statement by the patient about what he or she would or wouldn’t want if they were unable to express themselves,” Bicket says.

However, such documents aren’t as flexible as a health care power of attorney, both Halker and Bicket say.

“A health care power of attorney cannot imagine all the different scenarios that might occur, but you know the patient, you understand their values, and although you may not know exactly what they would want to do in every situation, you’ve had conversation enough so that you feel comfortable making that decision for the patient,” Bicket says.

A living will also can sometimes conflict with what has been expressed to the person who has power of attorney, or may not take into account advances in medical technology that have occurred since the document was created. A person with power of attorney has that flexibility. Plus, if there is a conflict, the entire question of a patient’s treatment may end up in court, where it will be completely removed from the family’s hands.

Even if that doesn’t happen, patients who have neither a designated health care power of attorney nor a living will are leaving their family members with some pretty tough decisions if an accident or illness happens and they’re unable to talk.

“If you have controversies between family members or for that matter between hospital physicians and the family, it’s helpful to know what the patient’s wishes were at some point in time,” Bicket says.

“It’s really the conversation between the family and the patient that’s most helpful. Unfortunately, I think what’s happened is that we all sort of talk at each other and we shake our heads like we’re understanding what we think we’re saying. We think people are understanding, but in reality they’ve often come to different understandings of what the patient said or meant. So the more conversation there is before we find ourselves in that decision-making position, the better it is for the patient and the family.”

CMDA resources

The Christian Medical and Dental Association offer two documents for Christians considering advance directives:

“Advance Directive for Health Care: A Christian’s Guide” defines terms, offers suggestions for creating one, explains one’s approach from a Biblical perspective, offers suggestions to the patient’s family on making decisions, and lists further sources on the subject.

“Reflecting Christian Values in Your Advance Directives” suggests several questions to consider when drafting an advance directive and offers an example.