The person to whom the power to consent will be delegated should not have
any conflicts of interest—emotional, financial, or professional— with the
patient. The most obvious conflict is between the physician and the patient.
Although the physicians caring for the patient certainly have the patient’s best
interests in mind, they cannot both propose treatments and consent to them.
Physicians and other medical care providers should not allow themselves to be
given the right to consent to care by a patient for whom they may have to
provide treatment. This does not prevent physicians’ acting for friends or
relatives when their role is to act as the patient’s advocate.
There are two types of conflict of interest between family members: conflicts
related to loss of objectivity about the medical problems of a loved one and
conflicts related to interests in the property or authority of the relative. For
example, assume that a woman authorizes her husband to consent to her
medical care during a severe illness. When significant treatment decisions
must be made, the husband will find it difficult to put aside his concern for his
wife and make objective decisions. He may feel guilty that she is ill and he is
not. He may feel that he has contributed to her illness. He may even resent
her illness and seek to punish her for being ill. The result is irrational decision
making. The husband may blindly accept the proposed treatments or, less
frequently, unreasonably refuse to consent to necessary treatments.
This issue should be discussed with patients who seek to execute a power of
attorney to consent to medical care. It is important that patients realize the
heavy burden that accompanies the right to consent to medical care for a
loved one. They should consider whether they have a close friend or more
distant relative who would be better able to make objective decisions and
weather the pressures associated with the decisions.
Financial conflicts of interest also are inherent in family relationships. Returning
to the example of the husband who has power of attorney to consent to his
wife’s care, if their resources are limited or the proposed treatment is very
expensive, the husband will have to choose between paying for his wife’s care
or the needs of other members of the family. A third party can make more
reasoned decisions about allocating resources and is less likely to consent to
questionable treatments that the couple cannot afford.