Someone close and dear to you has asked you to be ready to make health care decisions in the event that he or she becomes incapable of such decision-making. We should make some definitions clear so it is easier to discuss this situation:


PRINCIPAL--this is the person who has executed and

signed the Power of Attorney for Health Care document, (POAHC)


AGENT--this is the person selected by the Principal to assume the decision-making role in the event of his or her incompetence.


INCOMPETENCY--a condition in which the Principal is unable to understand the medical condition well enough to make meaningful decisions. This can be temporary or permanent, and must be decided by two physicians or a physician and a psychologist. At any time if the Principal returns to a state of competency, the Agent is no longer empowered to make the decisions.


To act as an Agent may seem like an awesome responsibility. But remember that you will  not be making your decisions, but rather making the decisions you know the Principal would have wished. You will be able to gather all the information from the medical staff and institution that the patient would have  been able to have. You will have a better idea than anyone else of what the Principal would have wanted, and you have the authority to see that treatment is offered or withheld according to those wishes.


For example, your mother has often expressed her strong feelings against living in a coma or otherwise totally unable to relate to the people around her. She made you her POAHC at a time when she was fully competent. Now she has bad a disastrous stroke and has been comatose for several weeks. The neurologist has said that she has no chance of regaining consciousness. When she develops a high fever and pneumonia you can let the doctor and the caregivers know that she would not want antibiotics to cure her pneumonia and prolong her comatose life. At first thought you may think that to make that decision is to wish for your mother's death yourself, and you might be very reluctant to speak out. However, you are actually making the decision for your mother that she has repeatedly let you know is the result she would want in this situation. Difficult as it may seem the decision you make for her is an act of love and respect for her autonomy.


You can see that before agreeing to be the Agent for someone you would want to have not one but several conversations on the general subject of the Principal's view of his or her values and the meaning of life, as well as more specific thoughts about feeding tubes or other technological interventions. You would also want to be sure you could be comfortable carrying out your mother's wishes. If your values differed significantly, you might suggest that you wouldn't be a suitable Agent.


Many families have found that these conversations are not as difficult or painful as they anticipated. Most people have thought about their wishes and welcome a chance to discuss them with their families. Knowing that death ultimately comes to us all, there is a security in knowing that we have shared our thoughts with those we most love. Sometimes it may seem more suitable to select a close friend as Agent, rather than a relative who may find it difficult or impossible to make decisions for the loved one.


Mary Frantz, M.D.

February 19, 1997