"My grandmother is 91 and has been in a nursing home for three years. When she was admitted, she and I met with a geriatric psychiatrist and a lawyer, and she signed over medical power of attorney to me. That gives me the legal right to make all medical decisions on her behalf. She told me at the time that she did not want her life extended for any reason, although if she were ill she wanted medication to ease pain.
"Last week, after suffering a fall, she underwent a series of X-rays at the local emergency room. The attending physician found a bone tumor in her hip. He didn't know, he said, whether it had originated in the hip or had spread from another site, and he explained the various options -- including invasive surgery to remove the cancer (along with the possibility of hip replacement, the insertion of steel rods and several months of physical therapy or perhaps even amputation). We also could have opted for tests to determine whether the cancer had spread and for the appropriate treatment if it had -- including more surgery and chemotherapy.
"I had no trouble answering his question about what to do: Nothing.
"Surprisingly, he agreed with me.
"This decision could have been among the most agonizing of my life had I not talked with my grandmother beforehand about what kind of medical intervention she wanted in her life and if I had not obtained the medical power of attorney. Now I feel no conflict about the decision and no burden in carrying it out. I know I am carrying out HER wishes rather than making a life-and-death decision for her on my own.
"Please let your readers know how important it is not only to give someone you trust a medical power of attorney, but also to talk with that person about what you want done at a time of medical crisis. -- L.C., Baltimore
When you give someone the power of attorney in medical matters, you must assume that you are potentially handing that person the power to decide whether you live or die.
A good power-of-attorney document should include some guidance as to your preferences about the use of life-sustaining procedures in the event you become terminally ill or permanently unconscious. Many people state that they want to forgo these procedures but specifically note that they do not want to give up measures that would provide comfort or relieve pain.
In general, including these details can give your document more authority and increase the chances that your wishes will be followed.
But in real life, it is impossible to foresee every circumstance. That's why designating someone you trust to make decisions can be a better step than simply signing a living will.
But providing for someone you trust to have the power of attorney in making your health-care decisions should always be a two-step process -- drawing up and signing the document AND discussing your wishes and preferences with that person.
As this letter points out, that discussion is as much for the sake of the person you are asking to shoulder this important responsibility as for you.
Put yourself in their shoes. If you take on the responsibility for making decisions for a relative or friend without feeling some assurance that you know how they feel about life and death -- whether the issue is discontinuing life-sustaining treatments or deciding to forgo major surgery or chemotherapy at 91 years of age -- then you might find yourself feeling like you are playing God without adequate preparation for the role. In a situation like that, making life-or-death decisions for another person can turn out to be a terrible burden that creates anguish and produces lingering guilt.