My wife is in a state of confusion so that mostly she doesn't know where she is etc. How do I get a medical POA without her conscious consent?

From your description of her state of mind, I don't think she could grant you medical POA with her consent and you can't just get it without her consent. Sorry to be the bearer of bad news. I hope her doctor can diagnose the cause of her confusion and find something to do about it. Otherwise, your only other option is to go to court for guardianship which will need the testimony of a doctor or two saying your wife is no longer competent to conduct her business in a business like manner.

Thank you. I was afraid of that, but thought there might be something...

The only other option is Guardianship, sorry.

Go to an elder law attorney. If your mom can understand "in the moment" - even though she forgets? He's likely to let her execute medical and financial powers of attorney. My mom's doctor completely agreed with that assessment...he was more than willing to sign a competency statement for mom after questioning her...he said he does it frequently in nursing homes. *shrug*

Looks like my best bet is to catch -my wife- in a lucid moment and get the POA then.

Thanks all.