Sometimes, patients cannot make decisions about their medical care, money, or other life areas. In healthcare, this can be temporary, long-term, or permanent. For example, a patient who is sedated for surgery is temporarily unable to talk to their doctor.
Advanced Care Planning gives direction and legal protection to the patient and family. The medical decisions made for the patient follow the patient’s wishes, beliefs, and values.
There are different Advanced Care Planning documents for different areas of the patient’s life. We recommend you work with a lawyer to complete these documents.
Advanced Directives
Document: Power of Attorney for Healthcare (or Medical Power of Attorney or Healthcare Proxy)
- A patient uses this legal document to identify an agent (or proxy)
- The agent can make medical decisions for the patient, following the patient’s wishes
- The patient can include restrictions for decision making
- The agent can only make decisions if the patient’s medical team decides the patient cannot make decisions
- Every agent and every healthcare provider must have a copy of this document
Document: Living Will
- A patient uses this legal document to document their wishes for medical treatment
- Living Wills cover: CPR, breathing tubes, tube feeds, antibiotic medications, pain management, dialysis, organ and tissue donation, etc
- A Living Will is limited to the information everyone has at the time it is written
- Every agent and every healthcare provider must have a copy of this document
Patients and agents must talk about the patient’s values, wishes, and priorities, especially how important independence and self-sufficiency are to the patient. For example, does the patient want treatment to stay alive, even if they need a feeding tube?
The American Bar Association has a Health Care Advance Planning Toolkit to help with these conversations.
Find state specific or universal power of attorney forms in Resources.
If a patient does not have a medical power of attorney, they can ask for the document at the hospital (if they are competent enough to sign it).
Legal Next of Kin
When a patient cannot make medical decisions but they don’t have a Power of Attorney for Health Care, the legal next of kin can make decisions.
Most states have laws that decide who is a patient’s legal next of kin. Usually, if the patient is legally married, the spouse is the legal next of kin. Consult with your healthcare team for clarification of the rules specific to your state.
Power of Attorney for Finances
Document: Power of Attorney for Finances
- A patient uses this legal document to identify an agent (or attorney-in-fact)
- The agent can make money decisions for the patient
- This document can be effective immediately or when a specific situation happens
- Patients should work with a lawyer to complete this document
Managing Social Security/Veterans Benefits
The Social Security Administration and Veterans Affairs will not recognize a Power of Attorney for Finances.
If the patient receives Social Security Benefits (like retirement), they must identify a “representative payee.” The payee will receive Social Security Benefits and manage them for the patient.
If the patient receives Veterans’ Benefits (like disability), they must identify a “VA fiduciary.” The VA fiduciary will receive VA benefits and manage them for the patient.
Learn more about social security and veterans’ benefits in Resources.
Guardianship
Rarely, an adult patient may need a guardian if they cannot care for their own well-being because of a mental incapacity or disease.
Guardianship:
- Is a legal process that goes through the court system
- Takes rights away from a person who cannot make decisions by themselves
- Gives decision-making authority to a court-appointed guardian
- Differs by state.
Learn more in the American Bar Association’s “Adult Guardian Handbooks by State,” found in Resources.
If needed, talk about guardianship with the transplant team to choose appropriate caregivers.
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