The basic vehicle for an adult to delegate his or her right to consent to medical
care is the power of attorney to consent to medical care. In the simplest case,
the person delegates all medical decision-making power to another competent
adult, for a fixed period of time or an indefinite period. A competent patient
may always revoke a power of attorney to consent to medical care.
Few states have laws forbidding the use of a power of attorney to delegate the
right to consent to medical care. Conversely, some states do not specifically
outline what a power of attorney may be used for. Although the U.S. Supreme
Court has not ruled that the right to delegate medical decision making is
protected by the Constitution, it has endorsed the use of powers of attorney to
consent to medical care. In the absence of a specific state law or state court
decision forbidding the use of a power of attorney to delegate the right to
consent to medical care, this is a valid method of proxy consent for adults.
The person making the delegation must be legally and medically competent at
the time the power of attorney is signed. These documents are usually
notarized, but the notarization has little legal significance. The notary public
may testify only as to the signer’s identity, not the person’s competency. If the
person delegating the power to consent to medical care has a condition that
might affect his or her competency, a physician, preferably not the patient’s
usual attending physician, should evaluate the patient and swear to the
patient’s competence. This should be incorporated into the power of attorney
to forestall attacks on its validity. The person to whom the right to consent has
been delegated must be medically and legally competent to exercise this right.
If he or she is not competent, the patient must be informed and asked to
appoint a new person to consent to care. If both the patient and the person to
whom the right to consent has been delegated are incompetent, then a court
order must be sought to determine who is legally able to consent to the
patient’s care. The patient may appoint an alternate decision maker in the
power of attorney and may specify under what conditions this person will serve.