Difficult Patients
Abstract
We appreciate and supLeongâs thoughtful cornments about the use of durable power of attorney with psychiatric patients in situations of shifting competency. However, as a practical matter, durable power of attorney, as it is currently incorporated in law, would be useful only in a limited set of circumstances. Durable power of attorney statutes have been designed for mdividuals who are taking action to ensure that their wishes will be carried out when they are incapacitated by terminal illness. The design of these statutes renders this device inapplicable in treatment refusals. Since competent patients can revoke durable power of attorney at any time, the patient mefusing treatment need only revoke power of attorney to thwart a proxy who has decided in favor of treatment. The need to assess the patientâs competency to refuse treatment would then be replaced by the need to assess competency to revoke power of attorney, and little has been gained. In a proposed statute now under consideration in New York, competency is not even a requirement for nevoking durable power of attorney. Durable power of attorney would be useful in the less cornmon situation in which a patient consents to treatment but appears to lack