Here are some sample cases that illustrate why having a health care power of attorney is important.
Case 1
An elderly woman is dying of stomach cancer. There's a surgery that could extend the patient's life for a couple of months. The patient does not possess decision-making capacity, but she has three children who are her surrogate decision-makers. One daughter says that her mom wouldn't want the surgery, and so is opposed to it. The other daughter says they must do everything to extend their mother's life. The son doesn't want to participate in the discussion.
This case is difficult because you have a tie. You have one daughter against the surgery, and one daughter in favor. Had the patient named someone as her health care agent, this impasse could've been avoided.
Case 2
An elderly man suffers a catastrophic brain injury, causing him to fall into a permanent unconscious state. The patient's son has been his father's caretaker for a number of years and believes that he would want to be kept alive. However, the patient's wife disagrees. The son informs the team that though the two are technically still married, they've been estranged for ten years. Thus, the son believes that he should have the authority to make the decision.
This case is difficult because, by law, the wife is the surrogate decision-maker. Spouses trump children. But according to the son, the two have been estranged, which gives reason to think that the son has a better idea of what the patient would want. Again, this situation could've been avoided if the patient had filled out a health care power of attorney.
Case 3
An elderly woman has necrosis of the left foot due to diabetes. The medical team recommends amputation. The patient adamantly refuses, even though she's informed that it could lead to a lethal infection. However, the patient also states that she doesn't want to die. The team is unsure of what to do. To make matters worse, the medical team is unsure if she possesses decision-making capacity.
The team has been trying to communicate with the patient's brother, as he's the only legal next of kin. However, the brother often doesn't pick up his phone and has missed the previous two meetings at the hospital. When they are able to get in touch with the brother, he's indecisive.
This case is difficult partly because the patient's brother isn't a reliable surrogate decision-maker, and he's the only legal next of kin. Had the patient named someone as their health care agent, this situation could've been avoided.
Now, it's possible that the patient would've named their brother as their health care agent, in which case, it wouldn't have helped. However, when people select a health care agent, they presumably choose someone reliable. Therefore, realistically speaking, if the patient had chosen a health care agent, it likely would've prevented this problem.
First, if you don't choose someone to be your surrogate decision-maker, the law will. And you may not like who it chooses.
And second, if you decide to have a health care agent, pick someone who will reliably make decisions according to your values.