Takeaways
- A health care proxy makes medical decisions, and a durable power of attorney (DPOA) agent handles financial and legal matters if you become unable to manage your affairs.
- Disputes can arise when different people fill these roles, often because of overlapping decisions (like paying for care), differing interpretations of your wishes, or poor communication.
- To avoid conflicts, you must clearly define each agent’s authority, choose agents who can collaborate, and openly communicate your values and wishes to both individuals.
As people plan for aging, illness, or unexpected disability, two legal tools often come into play: the health care proxy, or medical power of attorney, and the durable power of attorney (DPOA), sometimes referred to as a financial power of attorney. Both involve appointing someone you trust to act on your behalf. However, their responsibilities are different.
Some people select the same person to cover both roles; others choose two different people for the roles. When two different individuals are selected, the potential for conflict, especially during a crisis, can increase. Understanding each role and taking steps to coordinate them can help avoid disputes.
What a Health Care Proxy Does
A health care proxy, sometimes called a health care agent or medical power of attorney, is the person you name to make medical decisions if you become unable to make them yourself. (The specific name of the document and the agent vary from state to state.) Your appointed health care agent typically has the authority to act on decisions regarding your:
- Medical treatments, procedures, and medications
- Hospital or facility transfers
- End-of-life care
- Access to medical records
- Choosing or dismissing medical providers
You should choose a health care agent who will follow your wishes as specified in any advance directives you execute or any conversations you have with them. Keep in mind that they have authority only over health care matters, which can cost money, but they don’t have authority over your finances.
What an Agent Under a Durable Power of Attorney Does
An agent (or attorney-in-fact) under a durable power of attorney handles financial and legal decisions on your behalf. This document must be explicitly designated as “durable” to remain legally effective if you become incapacitated (unable to manage your affairs).
Some DPOAs become immediately effective upon signing, while others (known as “springing” powers of attorney) “spring” into effect only if you lose capacity. Your agent’s authority may cover tasks such as:
- Paying bills and managing bank accounts
- Filing taxes
- Managing investments or retirement accounts
- Handling insurance matters
- Selling or managing property
- Applying for public benefits, such as Medicaid and Supplemental Security Income
An agent’s power can be broad or limited, depending on how the document is written. Crucially, the DPOA agent cannot make health care decisions unless the document explicitly includes such authority.
Why Disputes Happen
When two different people are selected to serve as health care proxy and financial agent, conflicts may arise due to various reasons, including:
- Overlapping decisions. For example, a health care proxy chooses a skilled nursing facility, but the DPOA agent controls the funds to pay for it. (Typically, the DPOA agent is legally obligated to use your funds to pay for the medical care decisions made by the health care proxy, provided the funds are available. The DPOA agent’s role is to facilitate the payment, not override the medical choice.)
- Differing interpretations of the patient’s wishes. One agent might prioritize quality of life while the other is more concerned with preserving assets.
- Personality clashes or long-standing family tensions. Individuals with vastly different personalities may struggle to agree on how to handle matters and long-standing tensions can create conflict even if they don’t have anything to do with health care decisions.
- Lack of clarity in legal documents. Unclear language can lead to different interpretations and disagreements.
- Lack of communication during a medical crisis. Conflicts and delays can arise if agents aren’t communicating effectively.
Disagreements such as these can delay critical decisions or even lead to court involvement. When appointing agents, keep in mind that their roles are distinct from those of other concerned family members. While family input is natural, only the legally appointed health care proxy and DPOA agent have the authority to act on your behalf. This distinction must be clearly understood by all involved to prevent unauthorized interference, which can further complicate an already difficult situation.
External pressure from relatives who disagree with an agent’s decision – even if the decision aligns with your stated wishes – is a frequent cause of friction. Selecting agents who are resilient and capable of standing firm in the face of emotional pushback is essential.
How to Avoid Disputes Between a Health Care Proxy and a DPOA Agent
Choose Agents Who Can Work Together
If you appoint different individuals, choose people who:
- Communicate well
- Are willing to collaborate
- Can handle stress calmly
- Understand your values
- Respect the boundaries of their respective roles
When possible, select individuals who already get along.
Clearly Define Each Person’s Authority
Well-drafted legal documents can help prevent confusion.
- Make sure the health care proxy document clearly spells out the medical agent’s powers.
- Ensure that the DPOA specifies the agent’s financial and legal authority.
- State explicitly that the health care proxy’s medical decisions take precedence in medical matters.
- Clarify how disputes should be resolved.
An elder law or estate planning attorney can tailor the documents to your personal situation.
Share Your Wishes in Writing and in Conversation
Written advance directives are essential, but conversations add important context. Talk to both agents, together if possible, about:
- Your values regarding end-of-life care
- Preferences for long-term care settings
- What “living well” means to you
- How you want medical decisions weighed against financial considerations
The better your agents understand your priorities, the less room there is for disagreement.
Encourage Regular Communication Between Agents
Ask your agents to keep each other informed, especially during a medical crisis. Helpful practices include:
- Sharing updates on medical status
- Discussing whether financial decisions need to accommodate medical choices
- Consulting each other before making major decisions
- Documenting conversations when appropriate
Good communication helps reduce misunderstandings and builds trust.
Consider Naming a Backup or Mediator
You may want to designate:
- Alternate agents if for some reason the primary agent cannot serve or if conflicts arise
- A professional fiduciary, such as a care manager or attorney, for financial or medical oversight
- A family meeting facilitator to help with communication as your needs evolve
Some individuals choose one person for both the financial and health care roles to minimize conflict. This solution may be best if that person is good with financial decisions and also understands medical issues.
Review Documents Periodically
Your wishes and your relationships may change over time. Revisit your health care proxy and DPOA documents every few years or following major life changes, such as:
- Declining health
- New diagnoses
- Divorce or remarriage
- Death of an agent
- Changing financial circumstances
Keeping documents up to date prevents disputes and ensures the right people are in the right roles.
Learn More
A health care proxy and a durable power of attorney are powerful legal tools that help protect your interests when you can no longer advocate for yourself. Though these two roles are distinct, they often intersect during critical moments. By choosing trustworthy agents, documenting your wishes clearly, fostering communication, and periodically reviewing your plans, you can dramatically reduce the risk of conflict — and ensure your wishes are honored.