When it comes to planning for future healthcare decisions, two documents come up repeatedly: the medical power of attorney and the living will. While many people use these terms interchangeably, they are actually distinct legal documents that serve different purposes. Understanding the differences between them, and why you likely need both, is essential for ensuring your healthcare wishes are honored.
What Is a Medical Power of Attorney?
A medical power of attorney (also called a healthcare proxy, healthcare power of attorney, or durable power of attorney for healthcare) is a legal document that appoints someone you trust to make medical decisions on your behalf if you are unable to make them yourself.
The person you appoint is called your healthcare agent, proxy, or surrogate, depending on your state. This person steps into your shoes and communicates with your doctors, reviews treatment options, and makes decisions based on your known wishes and values.
A medical POA is activated when your physician determines that you are unable to make or communicate your own healthcare decisions. This could be because you are unconscious, under anesthesia, suffering from dementia, or otherwise mentally incapacitated.
The scope of a medical POA is broad. Your agent can consent to or refuse medical treatments, choose doctors and healthcare facilities, authorize or decline surgeries, make decisions about pain management and palliative care, and in some states, make decisions about organ donation or disposition of remains.
The key advantage of a medical POA is flexibility. Because you cannot predict every medical situation you might face, having a trusted agent who understands your values and preferences allows for nuanced decision-making that adapts to the specific circumstances at hand.
What Is a Living Will?
A living will (also known as an advance directive or directive to physicians) is a written document that spells out your specific wishes regarding medical treatment in certain situations. Unlike a medical POA, a living will does not appoint anyone to make decisions for you. Instead, it provides direct instructions to your healthcare providers.
Living wills typically address end-of-life scenarios and life-sustaining treatments. Common provisions include whether you want to be placed on a ventilator or breathing machine, whether you want artificial nutrition and hydration through a feeding tube, your wishes regarding cardiopulmonary resuscitation (CPR), whether you want dialysis if your kidneys fail, and your preferences regarding pain management, even if pain medication might hasten death.
A living will takes effect when you have a terminal condition, are permanently unconscious, or are in another qualifying medical state as defined by your state's law. It provides clear, documented guidance so that doctors and family members do not have to guess what you would want.
Key Differences Between the Two Documents
While both documents deal with healthcare decisions, they differ in several important ways.
Decision-maker vs. instructions. A medical POA appoints a person to make decisions. A living will provides specific written instructions. The medical POA gives your agent discretion; the living will removes discretion by stating your wishes directly.
Scope of situations covered. A medical POA can cover any healthcare decision when you are incapacitated. A living will typically applies only to end-of-life situations or specific medical scenarios that you have addressed in the document.
Flexibility. A medical POA is more flexible because your agent can respond to unexpected situations and evolving medical circumstances. A living will is more rigid, covering only the scenarios you anticipated when you wrote it.
When they apply. A medical POA applies whenever you cannot make your own medical decisions, regardless of whether the situation is life-threatening. A living will generally only applies when you have a terminal illness, are permanently unconscious, or meet other specific criteria defined by state law.
Why You Need Both Documents
Given these differences, relying on just one document can leave gaps in your healthcare planning. Here is why having both provides the most comprehensive protection.
A medical POA alone may not be enough because it depends entirely on your agent's judgment. While you should choose someone who knows your values, there may be situations where your agent is unsure what you would want, especially regarding end-of-life care. A living will removes that uncertainty by providing your explicit instructions.
A living will alone may not be enough because it cannot cover every possible medical scenario. Medicine is complex, and situations arise that you could never have anticipated. A living will also requires interpretation, and without a designated agent, family members or doctors may disagree about what your instructions mean in a particular context.
Together, these documents create a comprehensive framework. Your living will provides your baseline instructions for specific scenarios, and your medical POA agent fills in the gaps for everything else, guided by your values and preferences.
How the Documents Work Together
In practice, when both documents exist, they complement each other. If a situation arises that your living will directly addresses, your healthcare providers follow those instructions. If a situation arises that your living will does not cover, your medical POA agent makes the decision. If there is any ambiguity in your living will, your agent can help interpret your wishes based on conversations they have had with you.
Most states recognize both documents, and many states have combined forms called "advance directive" forms that include both a healthcare proxy appointment and living will provisions in a single document.
It is important that your living will and medical POA do not contradict each other. If your living will says you do not want life support, but your medical POA agent requests it, this creates a conflict. To avoid this, discuss your living will provisions with your agent so they understand and can advocate for your documented wishes.
State-by-State Variations
Both medical POAs and living wills are governed by state law, and requirements vary significantly. Some states use different terminology. For example, what one state calls a "healthcare proxy" another calls a "durable power of attorney for healthcare." Some states require specific statutory forms, while others accept more flexible drafting.
Witness and notarization requirements also differ. Some states require two witnesses, others require notarization, and some require both. Certain states have restrictions on who can serve as a witness, often excluding family members or healthcare providers.
Because these laws vary, it is important to ensure your documents comply with the requirements of your state. Following the jurisdiction-specific execution instructions included with your documents ensures proper signing, witnessing, and notarization.
Take Control of Your Healthcare Planning
Planning for future healthcare decisions is not something anyone enjoys thinking about, but it is one of the most meaningful things you can do for yourself and your family. By creating both a medical power of attorney and a living will, you ensure that your wishes are known, your family is spared from making agonizing decisions without guidance, and your healthcare is managed according to your values.
mypoa.ai can help you create a medical power of attorney that meets your state's legal requirements, making the process straightforward and accessible. Pair it with a living will, and you will have a comprehensive healthcare planning framework in place.