Healthcare Power of Attorney
Emergency contact ≠ healthcare decision-maker.
The Agent's Authority Activates at Incapacity
A healthcare power of attorney (HCPOA) designates a person — the healthcare agent or proxy — to make medical decisions when the patient lacks decision-making capacity. The agent does not override the patient while the patient retains capacity.
Emergency contact and healthcare decision-maker are not the same role. An emergency contact is notified. A healthcare agent makes decisions. Clarify which role a person holds before a crisis requires it.
Capacity Is a Clinical Determination
Decision-making capacity is assessed by the treating clinician — it is not the same as legal competency, which is a judicial determination. Capacity is decision-specific and can fluctuate.
The four elements: understanding the information, appreciating how it applies to their situation, reasoning through the options, and communicating a consistent choice.
When No Agent Is Designated
Without a designated healthcare agent, surrogate decision-making defaults to a state-defined hierarchy — typically spouse, adult children, parents, siblings. The order varies by state.
The surrogate's standard: substituted judgment (what would the patient want, based on known values) when preferences are known; best-interest standard when they are not.
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