At work, I often present to nurses. I ask my audience to put up their hand if they have appointed a power of attorney for themselves. Few hands go up.
People look bemused for a minute. “Why would I need that when I’m still working?” they are asking themselves. “I’ve not got dementia yet.”
This mirrors the reply from patients and clients. “Plenty of time for that later. I’ve not lost my marbles yet,” is a typical reaction.
A power of attorney – or lasting power of attorney in England – is a legal document that lets you (the ‘donor’) appoint someone (who is then called the ‘attorney’) to help you make decisions on your behalf, or to support you to make decisions. You need this if, for some reason, you lack capacity to do it independently.
Anyone who is over the age of 18 can appoint someone. There are two types – one is for health and welfare decisions, and the other is for property or finance. You can decide whether you want just one person or more than one. You can also decide to have just health or just finance or both.
Your attorney doesn’t take over from the day you both sign. The power you are giving them only comes into play if something happens to reduce your capacity to decide for yourself.
One common reason for this is ill health, such as a stroke, where communication becomes difficult. You may be unconscious from an accident, and those round you are asking each other what to do next. It is often used in dementia, when mental capacity has faded.
It is a smart move to choose someone younger, because statistically they’ll still be around when you start to have any serious ailments. It is even smarter to talk to them about what sort of decisions you expect them to make on your behalf.
It will be their call eventually, but at least they know what you would have wanted. If circumstances have arisen that could never have been anticipated and you are not able to say what you want, they can make a best guess on what to do instead.
That’s better than having well-intentioned authorities who know nothing about you taking charge. It’s also kinder to professionals caring for you to have the reassurance from your attorney that they’re doing what you’d have wanted.
“The death of our patients is part of the reality of nursing, but we fear death and loss of capacity as much as the next person”
So why are nurses so reluctant to take this step? It could be the cost of a lawyer – but you can fill out the forms yourself or do it online. A family member or friend may be as good for supporting you as a solicitor.
I suspect it is not the cost or the effort that holds us up. The death of our patients is part of the reality of nursing, but we fear death and loss of capacity as much as the next person. We are often in control of situations, and reluctant to think that one day we might not be.
I’d make a plea to all nurses to get one now. It’s a good thing for you and your family. It will start important conversations about the future. And once you have one, you’ll want to talk to your patients and clients about having one.
You should see the trouble and expense that is caused to patients and their families when this simple action has been missed – for example when you try to fix it after the diagnosis of dementia. It’s not a perfect solution, but without it, there is trouble ahead for everyone. And it is never too soon to get it. And you are never too young.
June Andrews is international consultant on the public understanding of dementia