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Decisions, decisions…who gets to decide?


By Orlando Gotay

Making health care decisions for yourself in Mexico is a snap—as long as you are capable of making them. What if you aren’t?

Understandably, this can be a very touchy subject. People don’t like to think about unpleasant situations of illness or injury. But these things may happen. And I suppose the worst scenario is that, during an incapacity, either temporary or permanent, health care decisions are made for you that perhaps run against what you would have wished for yourself.

Mexico (at federal level) and a few (but not all) states have in recent years provided for laws authorizing what you and I would label a “durable power of attorney. The “durable” part is important. In Mexico, “regular” powers of attorney become useless once the person granting the power is incapacitated. Durable powers of attorney enable the person holding the power to do the acts authorized by the document during the incapacity, and we are concerned here with medical decisions, including some care decisions in terminal situations, irreversible, or with little chance of recovery. The old adage “an ounce of prevention is worth a pound of cure” comes in handy. Planning ahead would be very wise.

Here’s some food for thought.

Whom will you designate to make these decisions? Is it a person you trust, who understands your values? Is the person local to you? It does not make much sense if your designee is in Michigan, has no passport, and would have to ask directions to get to where you live.

What kinds of things would you wish to be done for you if you were not around to decide? There are many Durable Power of Attorney forms for health care available online that can help as a starting point for your own list. They may also provide items you have not thought about, such as permission to move you back to the States, access to medical files, and many others, such as dealing with medical insurance companies on both sides of the border or even an emergency evacuation.

Consider having a document drafted in both English and Spanish to facilitate it being useful to medical personnel and to your designee. Having one such document, clearly expressing your preferences, may make the difference in many meaningful ways. It may just be honored. One thing is for sure, not having it virtually guarantees your wishes may not be known.

Orlando Gotay is a California licensed tax attorney (with a Master of Laws in Taxation) admitted to practice before the IRS, the US Tax Court, and other taxing agencies. His love of things Mexican has led him to devote part of his practice to the tax matters of U.S. expats in Mexico. He can be reached at


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