The phone call usually comes late at night. A son or daughter, 19 or 20, is in an emergency room after a crash on a two-lane highway, and the parents drive two hours to find out the hospital won’t let them make a single decision.
I hear some version of that story every few months. The fix is a medical power of attorney. What surprises families is how the document works after it’s signed.
When it starts
Missouri law calls it a durable power of attorney for health care. You name an agent, usually a parent for a young adult, to make medical decisions when you can’t.
The agent doesn’t take over the moment you sign. Under Section 404.825 of Missouri law, the agent’s power to make health care decisions begins when two licensed physicians examine you and certify in writing that you’re incapacitated. One of them can be your own doctor. When a physician certifies you’ve recovered, the decisions come back to you.
You can write a different trigger into the document. The law still requires at least one physician to certify incapacity. Some clients want two doctors as a check on an overeager relative. Others want one, because a small hospital at 2 a.m. may not have a second physician on the floor. Either is a reasonable choice. Make it on purpose.
What the agent can see
Section 404.840 gives your agent the same right you have to get information about proposed treatment and to review your medical records, unless your document or federal law limits it. The same section says a copy of the power of attorney goes into your medical record once your provider learns it exists.
That means you should hand a copy to your doctor now. I also have young adults sign a separate HIPAA authorization, so parents can get information in the hours before anyone has certified incapacity.
The decision you have to spell out
Missouri singles out one choice. Under Section 404.820, if you want your agent to have authority to stop a feeding tube or IV nutrition, you must grant that authority specifically in the document. A general line covering all health care decisions doesn’t do it.
The statute adds guardrails. No agent may authorize withdrawing food or water you can take by mouth with the intent of causing your death. Before artificial nutrition is withdrawn, the doctor must try to explain the plan to you and let you refuse, or certify that you can’t understand.
Most 19-year-olds have never thought about this. It’s a five-minute conversation in my office, and it spares a family from guessing in a hospital hallway.
Who can’t serve, and who can refuse
Section 404.815 bars your attending physician and the staff of a facility where you live from serving as your agent, unless they’re close relatives. Your mother can be your agent even if she’s a nurse at the hospital.
Doctors and nurses don’t have to carry out an agent’s decision that conflicts with their religious or moral convictions, under Section 404.830. Some facilities can refuse on the same grounds. None of them can stop your agent from moving you somewhere else.
Changing your mind
Section 404.850 lets you revoke the document any time, in any way you can communicate it, to your agent, your doctor or your health care provider. A new valid power of attorney cancels the old one unless it says otherwise.
Tearing up the paper at home isn’t enough. If the old one is in a hospital chart, tell the people who have it.
Students are coming home for Thanksgiving in a few weeks. That’s a good week to sit down at the kitchen table, pick an agent and get the paperwork signed before the next late-night call.
Patrick Nolan is an attorney with Nolan Law Firm in Kirksville. This column is general information about Missouri law, not legal advice.