Free Medical Power of Attorney

Table of Contents

1. The Basics: What is a Medical Power of Attorney?
   • Medical Power of Attorney PDF Sample
2. When a Medical Power of Attorney is Needed
3. The Consequences of Not Getting a One
4. The Most Common Medical Power of Attorney Relationships
5. What Should be Included?

1. The Basics: What is a Medical Power of Attorney?

A Medical Power of Attorney allows you to name a health agent, someone who will make health decisions for you if you cannot. Your health care agent will ensure that your health care providers give you the care you wish to receive. You can also require that your health care agent communicate in any manner with you about any specific proposed health care. For example, you may still be able to communicate by blinking your eyes.

A simple Medical Power of Attorney will identify the following basic elements:

• Health Care Agent: someone trusted who is at least 18 years old and mentally competent to make health care decisions.

• Alternate Agents: in case the first agent is unavailable or unable to make decisions.

• Agent’s Authority: the agent is authorized to make decisions that are in the principal’s best interest such that the benefits outweigh the burdens given the principal’s values.

• Effective Authority: the agent can begin making health care decisions immediately or only after a doctor declares the principal is unable to make their own decisions.

• Guardian: the principal can nominate someone who will be their legal guardian if required by court.

• Treatment: whether your agent can make decisions about life-sustaining treatment like artificial feeding, kidney dialysis, or breathing support, as well any preferences on surgery or chemotherapy.

• Witnesses: some states require two witnesses or a notary to sign the document.

SEE ALSO > Living Will: The Controversial Document We Shouldn’t Die Without

As a reference, people often call a Medical Power of Attorney by other names:

• Advance Medical Directive
• (Durable) Power of Attorney for Health Care
• Health Care Advance Directive
• Health Care Proxy
• Medical Durable Power of Attorney

For non-medical issues, please refer to our Power of Attorney form.

Medical Power of Attorney PDF Sample

The sample medical power of attorney below details an agreement between the principal, ‘Michelle R Kane’, and the health care agent, ‘William S Bryan.’ Michelle R Kane agrees to appoint William S Bryan as her health care agent, specifies the health care agent’s powers, and when these powers become effective.

Universal Power of Attorney (Medical)

2. When a Medical Power of Attorney is Needed

Why do I need a Medical Power of Attorney?

You should take the time to create a Medical POA, as it is commonly used when someone wants the peace of mind that their financial or health decisions will be made by someone they trust. The Health Care Agent steps into your shoes and can access your medical information and make decisions on your behalf.

You may need a Medical Durable Power of Attorney if you are:

• Over the age of 18 years old
• Military personnel being deployed overseas
• Traveling abroad for an extended period of time
• Diagnosed with a chronic condition or life-threatening illness
• Growing wiser and older but concerned about your current health
• Married and want your spouse to have legal authority over property you own
• Participate in extreme sports or activities that put your health at risk
• Engaged in a high-risk profession (i.e. emergency firefighter or member of police force)

3. The Consequences of Not Getting One

What happens if I do not have a Medical Power of Attorney?

Without one, your family may have to go through the process of formally appointing a guardian to manage your health care and treatment. Unable to choose your guardian, you doctor may listen to the wrong person about your personal preferences for certain medical treatment and end-of-life care.

Creating a Medical Power of Attorney in advance can help prevent the following consequences:

Individual Suffers	Individual's Family Suffers
Loss of time Unable to quickly make a health care decision until the court appoints a guardian	Loss of time Guardianship hearing in court Expensive lawyer fees to appoint or dispute a guardian
Embarrassment Declared legally “incompetent” Loss of personal dignity as a “ward”	Public Embarrassment Privacy of sensitive family situation goes before court
Loss of control Court appoints a guardian Your final wishes about end of life care or medical treatment are not respected	Loss of control Unable to administer your family member’s wishes
	Mental anguish Family disunity over medical treatment

4. The Most Common Medical Power of Attorney Relationships

Principal	Health Care Agent
18+ Year Old	Parent
International Traveler	Sibling
Extreme Sports Enthusiast	Children
Military Personnel	Friend
Married Adult	Community Member
Retired Person
Terminally Ill Patient

5. What Should be Included?

A Medical Durable Power of Attorney should generally address the following:

• Who do you trust to make health care decisions for you
• What kind of decisions can your health care agent make on your behalf
• When can your health care agent begin making medical decisions for you
• Why you prefer to continue or discontinue artificial life-sustaining treatment

You can specify whether you health care agent can make these additional decisions on your behalf:

• Mental Health Treatment
  • Admit you into an institution for mental diseases or state treatment facility
  • Give consent to experimental mental health research or psychosurgery
• Nursing Homes
  • Admit you into a nursing home
  • Admit you into a community-based residential facility
• Feeding Tubes
  • Withhold or withdraw a feeding tube
• Pregnant Women
  • Health care agent may or may not make healthcare decisions for you if they know you are pregnant
• Medical Records
  • Request, receive, and review all medical records (consider a medical records release)
  • Grant medical releases
  • Consent to disclosure of info
• Medical Treatment
  • Initiate or withhold a procedure
  • Start or stop a medical service
  • Modify medical care
  • Employ and discharge healthcare personnel
• Anatomical Gifts
  • Arrange or prohibit organ donations or donate your body

For further reading, the American Bar Association’s Commission on Law & Aging has compiled a useful Myths and Facts about Health Care Advance Directives.