One of the Biggest Mistakes to Avoid in Choosing a Medical Power of Attorney: “Daughter from California” Phenomenon

When someone is admitted to the hospital and is in critical condition, it usually comes at an unexpected time for the family. Local family members show up within hours to the hospital, while those who live out of town trickle-in a day or two later.

The local family (usually an adult child) is often more familiar with the patient’s medical conditions, and often, their more recent medical decline. This is simply because they see each other more frequently, but also can be because they are often in a caregiving role. That child and parent have sometimes had some conversations around end of life care, or have heard the parent make comments over the recent months about being “ready to go” or “I’d never want to suffer.”

The out of town family arrives in what I have termed the “Daughter from California Phenomenon” (that is, if you live on the East Coast. Or, you can think of this as the “out of town family member phenomenon”). The newly arrived family member is stunned by the patient’s poor health condition. They haven’t seen the recent decline up close in the way their closer relatives have and therefore, the decline appears to have happened much more dramatically. Additionally, there can be a component of guilt since they live far away, feel they haven’t visited enough, and are realizing that the time was more precious than they knew.

When it comes time to start making end of life decisions, things can get complicated. The local child is often ready to let their parent go, has come to terms with their failing heath, and based on some (even small) conversations, is confident their parent would not want this current quality of life prolonged. The “daughter from California,” on the other hand, remembers her parent’s health where it was when she saw them last, maybe six months ago over a holiday. This current state seems so starkly worse, so it seems it should be easily reversible. Additionally, she has the guilt of knowing she was not present before and feels like it is now too late.

She often advocates for more aggressive life prolonging measures.

Of course, these life prolonging measures are still temporary, or at least short lived. But in this time, while the daughters are disagreeing, their parent’s deteriorating condition has simply been prolonged. There is often animosity created between the siblings, and if they are lucky, it is only temporary.

Hence, formally naming an adult child as your medical power of attorney (POA) in your advance directive is key when one has been more involved in your medical care. It is also important to discuss your medical wishes with both children, even if only one is the POA so that their relationship is not jeopardized by these heavy and complicated decisions. You do not want one child to accuse the other of “pulling the plug” too early because she was not informed that this was, in fact, your medical wish.

Creating an advance directive and discussing it with all your children, whether one or all are your POA(s), is a gift you give to them. You make the decisions for yourself so they do not have to make the decisions for you and wonder if they made the right call.