Dying Matters Awareness Week:
Attorneys' Duties and End of Life Decisions
Making end-of-life decisions for someone who can no longer voice their wishes is a huge responsibility, but you may find yourself in a position of having to do just that if you have been appointed as an Attorney for a family member or friend under their health and welfare Lasting Power of Attorney (LPA).
When a person appoints a health and welfare Attorney under their LPA, they do so to ensure that their preferences and best interests are respected should they lose capacity. If the person making the LPA, (the Donor) has provided an advance decision (instructions about their preferred medical care), living will, or has discussed their end-of-life preferences, these should form the basis for the Attorney’s decision-making. The Attorney should honour the Donor's specific instructions to the fullest extent possible.
If the Donor's preferences are clear, this should greatly simplify the decision-making process but what should an Attorney do if the Donor has not made their wishes clear? How should they approach their responsibilities?
In such cases, the Attorney must make decisions that are in the Donor's best interests. Best interests will vary from person to person and there is never a one size fits all approach. The Attorney must assess the likely benefits and burdens of medical interventions, quality of life considerations, and the Donor's general values and beliefs. They should try to strike a balance between extending life and maintaining its quality.
End-of-life decisions often require medical expertise. The Attorney should consult with healthcare professionals to understand the Donor's medical condition, treatment options, and prognosis. This will help to guide decisions and ensures they are based on a sound understanding of the Donor's health status.
The Attorney, where possible and if appropriate, should involve the Donor's family and friends in the discussion. People closest to the Donor can often offer insight into their values and preferences. However, the Attorney should ensure that these discussions and opinions do not override their duty to act in the Donor’s best interests or lead to unnecessary delays in decision-making.
End-of-life decisions can be emotional for all involved. An Attorney should show respect, empathy, and sensitivity, with the dignity of the Donor being at the forefront of their mind.
All of this can be overwhelming for an Attorney, who may also have a close personal relationship with the Donor. Communication is vital, be it with family, friends or healthcare professionals. By doing so an Attorney can carry out their role with integrity and care and provide the best quality of life possible for the Donor in their remaining time.
