Formalizing the Patient’s Wishes
Every person, and especially every patient, should consider some formal provision for decision making should he or she become incompetent. The implication of the Cruzan decision is that a durable power of attorney may be the strongest legal provision. There are other benefits to using a durable power of attorney rather than a living will. [Orentlicher D. Advance medical directives. JAMA. 1990;263:2365.] Physicians do not like to discuss living wills with patients because it makes the patient face the issue of death. Living wills are also troublesome because they must anticipate future circumstances. Conversely, a durable power of attorney may be discussed in terms of the patient’s potential temporary incompetence during treatment. Durable powers of attorney are also flexible because they substitute a fully empowered decision maker who can carry out the patient’s intentions in the face of changing circumstances.