The Authority of a Medical Power of Attorney
A medical Power of Attorney (POA), also known as a healthcare proxy or durable Power of Attorney for Healthcare, is a legal document that designates an agent to make healthcare decisions on the principal's behalf if they become incapacitated. The agent's role is to act in accordance with the principal's known wishes and best interests. The agent's authority is significant, but it is not absolute. In most cases, a doctor must respect the decisions of a valid medical POA. However, there are limited circumstances where a doctor or hospital may legally challenge or refuse to follow the agent's instructions.
When a Physician Can Override a Medical POA
A doctor's ability to override a medical POA is not a discretionary power; it is based on specific legal and ethical grounds. These are usually limited to situations where the agent is acting improperly or where the medical request is outside the standard of care.
- Conscience Objection: In some states, a healthcare provider can refuse to follow a directive if it goes against their personal moral, religious, or ethical beliefs. However, in such a case, the provider or institution is typically required to transfer care to another provider who can honor the patient's wishes.
- Standard of Care Violations: If a medical POA's request is deemed medically ineffective or violates the accepted standards of healthcare, a doctor can refuse the request. This is common in cases where an agent insists on what a physician considers to be "futile care".
- Best Interest Disputes: If a doctor believes the agent is not acting in the patient's best interest, they can initiate a legal challenge. A court can then intervene to determine if the agent is abusing their authority or neglecting their duties. This is often the case when there is a dispute among family members.
- Improperly Executed Documents: A medical POA can be deemed invalid if it was not executed correctly according to state laws. Common issues include improper notarization, lack of required witnesses, or vague language that does not clearly outline the agent's authority.
- Conflict with an Advance Directive: If a patient also has a living will or other advance directive, and the instructions in that document conflict with the medical POA's decision, the advance directive often takes precedence. This is because the advance directive contains the patient's direct, explicit instructions.
- Pregnancy Exceptions: Some states have laws that allow doctors to override advance directives to provide life-sustaining treatment if the patient is pregnant. These laws often legally supersede any conflicting instructions in the advance directive, though the exact rules vary by state.
Challenging an Override and Legal Recourse
If an agent's decision is being challenged or ignored by a healthcare provider, there are several steps that can be taken. A doctor's refusal to honor a medical POA is a serious matter, and the process to resolve it must be followed carefully.
- Requesting a Second Opinion: The agent can request that the hospital bring in another physician for a second opinion on the medical necessity or standard of care.
- Involving the Hospital Ethics Committee: Most hospitals have an ethics committee that can be called upon to mediate conflicts between a patient's agent and the medical team. This can often resolve disputes internally without needing to go to court.
- Seeking Legal Counsel: If the conflict cannot be resolved, an attorney specializing in elder law can petition the court to intervene. The court's role is to ensure the agent is acting in the patient's best interests. Evidence will be required to prove the agent is overstepping their authority or neglecting their duties.
- Transfer of Care: In cases of irreconcilable differences, the medical institution may be required to facilitate the transfer of the patient to another facility or provider who is willing to comply with the agent's instructions.
Comparison: Patient's Wishes, Medical POA, and Doctor's Authority
| Entity | Decision-Making Priority | Circumstances for Challenge | Primary Role |
|---|---|---|---|
| Patient (Principal) | Highest (when competent) | Becomes incapacitated, voluntarily revokes, or new directive contradicts. | Retains absolute control over their healthcare while mentally capable. |
| Medical POA Agent | High (when patient is incapacitated) | Acting against the patient's best interests, violating standard of care, improperly appointed, or conflict with living will. | Acts as the patient's proxy, making decisions in line with their wishes and best interests. |
| Physician / Institution | Lowest (must defer to valid POA) | Conscience objection, requested treatment is futile or violates accepted medical standards, improperly executed documents. | Provides medical care and ethical guidance; must follow patient/agent's lawful directives. |
| Court | Highest (Adjudicated) | When a legal dispute arises regarding the validity of the POA, the agent's actions, or a serious conflict. | Has the final legal authority to validate, invalidate, or interpret the POA. |
Conclusion
While the medical Power of Attorney grants significant authority to a chosen agent, it does not provide an unlimited or unchallengeable right to override medical professionals. A doctor can legally refuse to comply with a medical POA's decision in limited, specific circumstances involving improper execution, ethical conflicts, or violations of medical standards. However, a physician's refusal requires careful consideration and adherence to legal processes, with the ultimate authority resting with the patient's clear wishes, the ethics committee, or the court. The best way to prevent conflict is to have a clear, well-executed advance directive and a candid discussion with the designated agent about your wishes.
To ensure your wishes are followed:
- Use clear, specific language in your medical POA.
- Discuss your end-of-life wishes with your agent and your family.
- Keep a copy of your POA in your medical file at all facilities you use.
- Periodically review and update your documents.
What is a Medical Power of Attorney (POA)?
A medical Power of Attorney, also known as a healthcare proxy, is a legal document that designates a person (the agent) to make healthcare decisions on your behalf if you become incapacitated. It empowers the agent to communicate with doctors, review medical records, and consent to or refuse treatment based on your wishes.
What happens if a doctor refuses to honor a medical POA's decision?
If a doctor refuses to honor a valid medical POA's decision, they are legally obligated to inform the patient and family of their objection. The doctor or hospital must facilitate the transfer of the patient to another facility or physician who can comply with the agent's request. In some cases, the dispute may escalate to mediation by a hospital ethics committee or even court intervention.
Can a doctor override a medical POA's decision if it goes against institutional policy?
Yes, a doctor or hospital can refuse a request if it violates their institutional policy, but this is a limited exception. Similar to a conscience objection, the institution is usually required to help transfer the patient to a facility where the request can be honored.
Can a doctor or hospital challenge a medical POA in court?
Yes, a doctor or hospital can petition a court if they believe the agent is not acting in the patient's best interests. This typically happens when the agent's decision is deemed medically inappropriate or harmful. A court can then remove the agent or issue a temporary order for care.
Can a pregnant person's medical POA be overridden?
In many states, yes, a doctor can override a pregnant patient's advance directive or medical POA to provide life-sustaining treatment, regardless of the patient's wishes. State laws vary, so it is crucial to research your specific state's rules regarding advance directives and pregnancy.
Does a living will take precedence over a medical POA?
Generally, yes, a living will takes precedence over a medical POA because it contains the patient's specific, explicit instructions. However, state laws and document wording can influence which directive is followed, especially if there are conflicts between the two documents.
What if a family member disagrees with the medical POA's decision?
Family members who disagree with a medical POA's decision cannot legally override it, but they can petition a court to review the agent's actions if they believe the agent is acting improperly. A court will then determine if the agent is acting in the principal's best interests.
How can a medical POA be revoked or challenged?
A medical POA can be revoked by the principal at any time as long as they are mentally competent. If the principal is incapacitated, a court can revoke or modify the POA if there is evidence of abuse, fraud, or neglect by the agent. Family members may also petition the court to challenge the agent's authority.
Keypoints:
- Medical Standard of Care: Doctors can refuse a medical POA's request if it violates the accepted medical standard of care or is deemed medically futile.
- Conscience Clause: Some states permit healthcare providers or institutions to refuse care based on a moral or ethical objection, but they must facilitate a transfer of the patient.
- Patient's Best Interests: A doctor can legally challenge a medical POA's decision in court if they believe the agent is not acting in the patient's best interests.
- Proper Execution: If a medical POA is not properly executed according to state law (witnesses, notarization, etc.), a medical provider may disregard it.
- Advance Directive Priority: An existing living will or other advance directive with specific instructions will often override a medical POA's conflicting decision.
- Pregnancy Exceptions: In some states, a doctor can override a medical POA to provide life-sustaining care to a pregnant patient, regardless of their stated wishes.
- Court Intervention: In complex disputes, a court has the ultimate authority to determine the validity of the medical POA or the actions of the agent.
