San Antonio Express-News
April 11, 2006

Using Medical POA with Alzheimer's Patient

copyright 2006, Paul Premack

It is very difficult to balance the needs of the family and caretaker, the needs of the patient, and the rights we all take for granted. As caretaker, your father feels responsible for your mother’s continued well-being. As patient, your mother needs some supervision but expects to be treated like an adult. It is a nuanced situation, but is manageable when you understand the law.

According to the Alzheimer’s Disease Research Center, Alzheimer’s is difficult to diagnose conclusively. The doctor is putting a name to a series of behavioral symptoms that may be very pronounced in some patients and very mild in others. There are specific types of dementia and memory loss that can be similar to Alzheimer’s without the actual brain damage that is the primary physical feature of Alzheimer’s disease.

Your mother is still employed so she must perform her job adequately, except for her spells of irritation. That is a pretty high level of function. Do you allow her to drive to work? If yes, you must have a high regard for her ability to make decisions since driving is a very dangerous activity for anyone, especially for someone with a cognitive impairment.

She retains legal capacity to make her own medical decisions until her physician determines that she is no longer capable of understanding the risks and benefits of a proposed treatment. The Medical Power of Attorney she signed was not an abrogation of her right to make her own decisions. In its very first paragraph, it says "This medical power of attorney takes effect if I become unable to make my own health care decisions and this fact is certified in writing by my physician".

If her doctor is still seeking her consent when your father makes a request, the doctor must feel that your mother is still capable of making her own health care decisions. If that is the doctor’s opinion, then she retains the legal right to consent or to withhold consent to any proposed medical treatment (even if the refusal may be harmful to her).

Her doctor may change that opinion as time passes and her symptoms worsen. That is when the Medical Power of Attorney becomes invaluable, as it authorizes your father as agent to make those decisions for her. Your father cannot take over until the doctor certifies that your mother is unable to make her own decisions. Perhaps it is time for him to meet with her doctor so they better understand each other’s positions.

In the meantime, your father can also be honing his caretaker skills. He can visit the Alzheimer’s Disease Education & Referral Center website, and can talk to the local Alzheimer’s Association to find a support group where he can share his feelings and concerns.