Free Connecticut Medical Power of Attorney Forms

Connecticut Medical Power of Attorney Laws

Connecticut General Statutes - Chapter 368w: Removal of Life Support Systems and Medical Orders for Life-Sustaining Treatment - The law outlines the appointment of a healthcare representative. The medical POA format states:

“I understand that, as a competent adult, I have the right to make decisions about my healthcare. There may come a time when I am unable, due to incapacity, to make my own healthcare decisions. In these circumstances, those caring for me will need direction and will turn to someone who knows my values and healthcare wishes. By signing this appointment of a healthcare representative, I appoint a healthcare representative with legal authority to make healthcare decisions on my behalf in such case or at such time (Conn. Gen. Stat. §19a-577).”

The same law provides guidelines on the removal or withholding of life support. The document must include a statement that provides the clarification: “I do not intend any direct taking of my life, but only that my dying not be unreasonably prolonged. (Conn. Gen. Stat. §19a-575)

Signing Requirements in Connecticut

A medical POA in Connecticut must be signed by a principal who is of legal age. The act of signing should be witnessed by at least two individuals.

How To Write a Medical POA in Connecticut

You can get a medical POA from a law firm in Connecticut or modify a downloadable printable form online. Here are the steps in writing a medical POA:

1. Identify Your Agent

The agent acts as the principal’s decision-maker if they are too incompetent to make medical choices for themselves. It’s an important role that may entail making life-and-death decisions for someone else. According to the previously cited Connecticut law, this may include the withholding or withdrawing life support systems. As the principal, you must choose an agent you trust with your life.

Many choose a spouse, sibling, or child. However, you can also choose someone who isn’t related to you or name more than one person as your agent so long as the document clarifies who are the primary and secondary agents.

2. Discuss the Agent’s Responsibilities or Powers

After identifying an agent, meet with them and discuss their responsibilities. The agent will become the decision-maker when the principal becomes incapacitated, but decisions must still be based on the principal’s wishes. That is why it is important to be clear about your preferences in healthcare management.

Inform them that they will be expected to make decisions on your behalf. This often involves choosing whether or not you should undergo medications, medical treatment, and procedures, among others.

3. Download the Connecticut Medical Power of Attorney Form

Download a POA template online. Make sure it is in the right format so that it will be recognized and binding in Connecticut. Fill out the form and list the specific arrangements or authorities you want to bestow on your agent.

4. Sign the Document

Review the document to ensure everything you need is clearly stated. As soon as you’re satisfied with the medical POA, you can sign the document and indicate the date of signing. In order to ensure the validity of the document, it must be signed with two individual witnesses present.

5. Use the Form

Provide your agent with a copy of the POA, as it will serve as their written permission to make decisions on your behalf. The agent can decide on the principal’s diet, nutrition, and living arrangements, as well as whether they should stay at home with a caregiver or at a facility.

Every time your agent makes a decision on your behalf, the attending physician or healthcare worker will need to see the document as proof that the agent has the authority to make such decisions.