A general durable power of attorney both authorizes someone to act in a wide range of legal and business matters and remains in effect even if you become incapacitated. The document is also known as a durable power of attorney for finances. The POA can take effect immediately or can become effective only if you are incapacitated. A financial durable power of attorney only allows the agent to handle financial matters. It does not permit the agent to make decisions about the principal’s health care.

It is important to note that each state has their own rules for validly executing a durable power of attorney (i.e., some require witnesses and a notary, others, only a notary).  This is true for both a financial power of attorney or a health care power. It is vital that you familiarize yourself with the particulars of your state.

The person you appoint is known as your agent, or attorney-in-fact. An attorney-in-fact can handle many types of transactions, including:

• Buying and selling property
• Managing bank accounts, bills, and investments
• Filing tax returns
• Applying for government benefits

Here are three reasons why you should have a strong durable power of attorney in place:

1. A durable power of attorney remains “durable” or effective even if you suffer an incapacitating illness or accident. This means your agent can continue to make decisions on your behalf and based on your wishes, even when you cannot act for yourself.
2. Without a durable power of attorney, you may be left with no one, or possibly too many, to represent your interests, such as your finances or business. A durable power of attorney gives you and your loved ones clarity about what you want when you may be unable to communicate.
3. Even if you prepare a durable power of attorney, you can revoke or terminate it at any time, so long as you are mentally capable. If so, you can revise the durable power of attorney over time, as your needs and wishes change.

Preparing a durable power of attorney can provide your family and friends with the clarity they need during a difficult time.

Without a durable power of attorney, no one can represent you unless a court appoints a conservator or guardian. That court process takes time, costs money, and the judge may not choose the person you would prefer. In addition, under a guardianship or conservatorship, your representative may have to seek court permission to take planning steps that he/she could have implemented immediately under a simple durable power of attorney.

Medical Power of Attorney – designates an individual to make healthcare decisions for you when you are not capable of making those decisions for yourself. When selecting a healthcare agent, ask yourself if that person:

1. will be willing to speak on your behalf,
2. will be willing to act on your wishes,
3. lives close by or can travel if necessary,
4. knows you well,
5. will be able to handle the responsibility,
6. will talk to you about sensitive issues,
7. will listen to your wishes,
8. will be available if necessary,
9. will handle conflicting opinions, and
10. will be a strong advocate for you.

While much of estate planning focuses on finances, a comprehensive estate plan should also help you prepare for any potential medical or healthcare decisions you may need to make in the future. That’s why a medical power of attorney, also known as a durable power of attorney for healthcare, is essential.

You may feel you don’t need a medical power of attorney. For example, maybe you already have a living will as part of your estate plan, or perhaps you’ve already expressed your wishes to your loved ones about the kind of healthcare you want to receive if you become incapacitated.

If you’re hesitant about the necessity of having a medical power of attorney, it’s important to understand who will make medical decisions for you if you can’t make those decisions on your own.

• Living will.If you have a living will, it will only be enacted if you are in a permanent state of incapacity. This is because a living will addresses end-of-life situations, and a key requirement is that you are permanently incapacitated. But if you are temporarily incapacitated—for example, if you fall into a temporary coma after an accident but your doctors expect you to eventually come out of the coma—your living will won’t be able to help with the healthcare decisions that may need to be made during this time.
• Your loved ones know what you want.It’s easy to see the potential for conflict that could arise in this scenario. Your loved ones may not correctly remember your instructions, may interpret your directions to them differently or may decide on religious or moral grounds that a different decision would be better for you. Having a medical power of attorney avoids these situations. Additionally, your state’s laws may give one of your loved ones priority in terms of medical decision-making power over another loved one who may be more likely to make medical decisions following your wishes.

In addition to using different terms to refer to the medical power of attorney, different states also have various ways to enforce laws regarding the medical power of attorney. Research what your state requires to ensure you have a legally binding medical power of attorney directive.

A medical power of attorney comes into play only in the case of serious medical conditions, incompetency and/or incapacitation. Examples of medical conditions that could require your medical power of attorney to act on your behalf include:

• Falling into a coma due to a stroke or other brain injury
• Losing the power of communication due to dementia or disease
• Having a lapse of mental health that prevents you from being of sound mind

Only a doctor may decide when a medical power of attorney applies in situations such as the above. If a physician decides you can’t speak for yourself, the medical power of attorney directive gives your agent control over taking the next steps so that you can get the best possible medical care according to your wishes.

Often, people choose a spouse, adult child, longtime partner, or best friend to act as an agent. Choose someone you trust, but only assign someone whom you know will carry out your wishes. If you know that a spouse or child will find complying with a preference, such as not inserting a breathing or feeding tube, difficult, you may consider appointing someone else to act as your agent.

No matter whom you select, the person you choose must be a mentally competent adult. Your agent should also be able to put aside his or her feelings about a given medical option or procedure to ensure your wishes get carried out. They should be able to understand medical explanations that your physician describes and ask challenging questions when necessary. You will want to discuss your medical wishes with them, including relevant specific scenarios. They will certainly need to understand your wishes about end-of-life care and medical options.

You may also consider appointing an alternate agent if your primary power of attorney can’t fulfill this responsibility. Once you select a medical power of attorney, you should talk with that person on an ongoing basis about situations that could occur. Continue discussing how you want your agent to handle these situations. Although it is impossible to anticipate every potential circumstance, the more you discuss your wishes with your medical power of attorney in general, the better the individual can understand your desires overall.

The durable medical power of attorney is an essential element in your estate planning tool kit. By utilizing a medical power of attorney, you’ll gain the peace of mind that comes with knowing someone you trust will be able to step in and make vital healthcare decisions for you if you can’t make those decisions yourself.

Directive to Physicians – A Directive to Physicians is a legal form, also known as a “Living Will.” It communicates your wishes about medical treatment at some time in the future, but only if your condition is irreversible or terminal. It speaks for you when you cannot speak for yourself.

A living will allows you to put in writing your preferences about some life-sustaining treatments. For example, you can indicate whether you want interventions such as cardiac resuscitation, mechanical respiration, or tube feeding by using a living will.

A medical power of attorney usually works together with a living will since the agent appointed via the medical POA can follow the wishes you outline in a living will. Overall, the medical power of attorney directive may offer more flexibility than a living will alone. One can’t predict every medical condition that could arise in the future in a living will. In many states, the medical power of attorney and living will get combined into one form known as an advance directive form.

Living wills and other advance directives are written, legal instructions regarding your preferences for medical care if you are unable to make decisions for yourself. Advance directives guide choices for doctors and caregivers if you’re terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life.

Advance directives aren’t just for older adults. Unexpected end-of-life situations can happen at any age, so it’s important for all adults to prepare these documents.

By planning ahead, you can get the medical care you want, avoid unnecessary suffering and relieve caregivers of decision-making burdens during moments of crisis or grief. You also help reduce confusion or disagreement about the choices you would want people to make on your behalf.

Out-of-Hospital Do-Not-Resuscitate Order (DNR) – DNR means “Do Not Resuscitate.” DNR orders are written instructions directing healthcare professionals not to initiate or continue certain life-sustaining treatments.  You do not have to be terminally ill to execute one.

Like all health care decisions, a decision about resuscitation should be based on a combination of your own values and preferences together with the medical facts and options for treatment. This should occur in a conversation with your physician and other health care providers that you know and trust. Talk to your doctor about what he/she would recommend, knowing you and your condition. Think about what is important to you and talk to family members and friends. It may be helpful to seek counseling from clergy, therapists or social workers, especially when you are making a decision for someone else.

People who are chronically ill often regard a DNR as a graceful way to leave the world on their terms. The details of a DNR are usually discussed at the time of admission to a hospital, nursing facility, or hospice program.

Procedures used to resuscitate someone include:

• Chest compressions: When a person’s heart stops beating, the heart cannot pump blood to the rest of the body, including the brain and lungs. Pushing down on the chest repeatedly can help keep blood flowing throughout the body until heart function is restored.
• Intubation: When breathing becomes difficult or impossible due to an illness or injury, a patient may be intubated. This involves inserting an endotracheal tube through the mouth and into the airway. The tube is then connected to a ventilator, which pushes air into the lungs.
• Cardioversion: Cardioversion is used to correct abnormal heart rhythms, including arrhythmias and atrial fibrillation (also known as AFib). This may be done using a set of paddles to deliver an electrical shock to the heart or via medication.
• IV medications: Medications that are sometimes used in the case of cardiac arrest include epinephrine, amiodarone, vasopressin, and atropine sulfate. These are “crash cart medications,” so named because they can be found on the wheeled cart that medical professionals use during an emergency resuscitation.

The application of DNR orders varies from state to state, especially regarding out-of-hospital (meaning ambulance) care. Some states have standardized forms for DNR orders; if the order is not written on that specific form, it cannot be honored. Other states are less regimented and honor any type of clear DNR order. If you wish to explore a DNR order, it’s important to know that the orders vary from state to state. So investigate the rules in your state before proceeding.

Designation of Guardian – A designation of guardian allows you to name the individuals who will be your guardian of your person and estate in the event of your incapacity or disability.

More importantly, this document allows you to name the individual you DO NOT want serving in that capacity.

Many discussions around estate planning involve the topics of wills and powers of attorney. However, a Designation of Guardian in Advance of Need is also an essential part of a comprehensive estate plan — especially for unmarried couples.

If you wish to explore a Designation of Guardian within your estate plan, it’s important to know that the documents vary from state to state. So investigate the rules in your state before proceeding.