Powers of Attorney for Personal Care: Great Power with Great Responsibility

BY PAUL B. ADAM

A Power of Attorney for Personal Care is a document that sometimes gets referred to, or thought of,
as a "living will" or "advanced care directive".

Those names have been introduced into our everyday terminology by way of television and the internet, but neither capture exactly what a power of attorney for personal care is, or how much of an impact it can have on someone's life.

When most people think about a living will, or their advanced directives, they think about a documents that is used in the very final stage of a person's life. This is partly due to the obvious analogy between a "Living Will" and a "Last Will." A Power of Attorney for Personal Care can be these things, but it can be much, much more.

A Power of Attorney for Personal Care is a document that is a creation of Ontario legislation, the Substitute Decisions Act. Among other things, it allows the "attorney" (the person acting on behalf of another) to determine a huge range of questions relating to medical treatment and personal welfare for the "grantor" (the person who made and signed the power of attorney for personal care in her own name), such as where the grantor will live, what level of medical treatment the grantor will receive, how and when the grantor will see her family.

Through advancements in medical science, nutrition and a better understanding of mental illness, most Ontarians are living a lot longer.

Some of us may regrettably go through a phase in life when we are no longer mentally capable of caring for all our needs by ourselves, but with the right supports, we can live stable, happy, relatively healthy lives.

Doing all of that, however, costs money and requires far-reaching decisions to be made. For many people, the person or people making the decisions will be the attorney (or attorneys) for personal care.

The decision of what to do in the final phase of a person's life can affect the grantor for a few days, weeks or months. This is especially if the primary concern is whether a dying person should be kept on artificial life-extending measures such as mechanical respiration, or allowed to pass more quickly, and with less pain. For choices like this, it can be appropriate and preferable to leave the decision to a family member like a spouse, who may be quite elderly, but who has known the grantor best and longest.

But the decision of where a grantor should reside over a long period of time- perhaps decades, and the type and quality of care the grantor should receive is something with huge financial and emotional repercussions for an entire family. A grantor with dementia, or multiple sclerosis, who is otherwise stable, may need years of attentive and very costly medical care. The grantor may also need personal care, mental stimulation and specialized treatments that will not be attended to unless the attorney sees to it personally.

The job of an attorney under these very difficult circumstances may require numeracy, an understanding of geriatric or psychiatric care (or both), energy and above all, time commitment.

The person who is best suited to do this may be very different from the person who ought to be carrying out end of life decisions under a "simple will."

It is therefore important to choose your nominated attorney under a POA for Care, with all of life's medical contingencies carefully considered, and with input from medical, care-giving, financial and legal professionals as may be appropriate.

- Paul B. Adam, Toronto

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