In times of medical emergencies or when facing end-of-life decisions, your ability to communicate your health care wishes might be compromised. To ensure your preferences are respected and you receive the care you desire, appointing a Health Care Proxy is crucial. A health care proxy is a designated individual authorized to make medical decisions on your behalf should you become unable to do so. This proactive step is a vital component of advance care planning, a process that involves thoughtful conversations and preparations for future health care decisions when you might lack the capacity to make them yourself.
What Exactly is a Health Care Proxy?
A health care proxy, sometimes referred to as a health care agent, surrogate, or representative, acts as your voice for health care decisions when you are unable to communicate your own choices. This person collaborates closely with your medical team, advocating for your treatment preferences and ensuring your values guide your care. Establishing a health care proxy is particularly prudent to prepare for unforeseen events such as severe accidents or sudden illnesses like a stroke, where immediate medical decisions are necessary and your input might be impossible.
The formal designation of a health care proxy is typically achieved through an advance directive known as a durable power of attorney for health care. An advance directive is a legal document that outlines your instructions for medical care, activated only when you lose the capacity to communicate your wishes directly. Choosing a health care proxy can complement or serve as an alternative to a living will. A living will is another form of advance directive that specifically details your preferences regarding particular medical treatments, especially end-of-life care.
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Advance Care Planning: A Conversation Guide
Interested in delving deeper into advance care planning? The NIA’s guide provides useful conversation starters, practical worksheets, and valuable insights.
Who is Eligible to Be Your Health Care Proxy?
The criteria for who can serve as a health care proxy are generally consistent across most states, though some variations exist. In the majority of states, an individual must be at least 18 years of age to be eligible. However, in Alabama and Nebraska, the minimum age is slightly higher at 19 years old. Universally, a health care proxy must be of sound mind, capable of understanding and fulfilling the responsibilities of the role. While many people choose a family member for this important role, you are also free to select a trusted friend, neighbor, or even a legal professional.
The American Bar Association provides helpful guidelines regarding who to avoid selecting as your health care proxy, generally advising against choosing:
- Your primary health care provider, or their spouse, employee, or spouse of an employee, to prevent conflicts of interest.
- Individuals who own or operate your health or residential care facility, or anyone employed by a government agency that is financially responsible for your care, to ensure unbiased advocacy.
- Professionals who are currently evaluating your capacity to make your own decisions, as their role might present a conflict.
- Your court-appointed guardian or conservator, unless there are specific, compelling reasons and safeguards in place.
- Someone who is already serving as a health care proxy for a large number of other individuals (e.g., 10 or more), as their capacity to dedicate sufficient attention to your needs might be compromised.
To ascertain the specific regulations in your state and to check for any other limitations on who can be your proxy, it’s recommended to contact your state legal aid office or state bar association. Furthermore, it’s a wise strategy to designate an alternate proxy, who can step in if your primary proxy is unavailable or unable to act when needed. This ensures a backup plan for your health care decision-making.
Key Considerations When Selecting Your Health Care Proxy
Choosing the right person to be your health care proxy requires careful thought and consideration. If you are contemplating a few individuals, reflecting on the following questions can guide your decision-making process:
- Comfort in Communication: Are you completely comfortable having open and honest conversations with this person about your health care wishes, personal values, and priorities?
- Respect for Wishes: Will this person genuinely respect your wishes and diligently strive to make decisions that align with your preferences when the time comes, even if they personally disagree?
- Trust and Confidence: Do you have unwavering trust in this person to make critical, life-altering decisions on your behalf?
- Conflict Resolution: Is this person capable of navigating and managing potential disagreements or conflicting opinions from family members, friends, and even health care providers, while still prioritizing your wishes?
- Availability and Accessibility: Does this person live in close proximity, or are they willing and able to travel to be with you if necessary, especially during a medical crisis?
It might be beneficial to discuss your health care wishes with several trusted individuals before making your final decision about who would be the most suitable health care proxy for you. Once you have identified a person you believe is the right fit, it is essential to have a direct conversation with them to ask if they are willing to accept this significant responsibility. Ensure they understand the role and are prepared to commit to it.
Scope of Decisions a Health Care Proxy Can Make
Your health care proxy’s authority to make decisions on your behalf only becomes active when you are deemed unable to make those decisions yourself. You have the ability to specify the extent of control your proxy will have over your medical care. This can range from granting them broad decision-making power across all aspects of your care to limiting their authority to only specific, defined decisions. You can also stipulate certain decisions that you prefer your doctor to make directly, and outline other preferences, such as requiring your proxy to consult with particular family members before making significant choices. However, it’s generally advisable to provide your health care proxy with some degree of flexibility to ensure they can effectively advocate for you and facilitate the best possible care in evolving medical situations.
While the specific responsibilities can vary slightly by state, common duties and powers of a health care proxy typically include:
- Medical Care Decisions: Authorizing or refusing specific types of medical treatments, procedures, surgeries, or other health care services on your behalf.
- Provider and Care Setting Selection: Choosing your health care providers, including doctors and specialists, and making decisions about where you will receive medical care, such as hospitals or care facilities.
- Medical Information Access: Accessing and overseeing information related to your physical and mental health, and managing your personal health affairs, including the right to review and obtain medical and hospital records.
- Post-Mortem Decisions: Making critical decisions about autopsy, tissue and organ donation, and funeral arrangements or the disposition of your body after death.
- Guardianship (If Necessary): Initiating proceedings to become your legal guardian if such a step becomes necessary to manage your overall well-being and care.
Additional important considerations regarding your health care proxy include:
- Revocability and Changes: You retain the right to change or revoke your health care proxy designation at any point in time, as long as you are mentally competent. To do so, you should complete a new durable power of attorney for health care form and promptly inform your family members, your health care proxy, and your medical team about the change.
- Alternate Proxy Designation: It is highly recommended to name an alternate health care proxy who can serve as a backup if your primary proxy is unavailable, unwilling, or unable to act when needed. This ensures continuity in your health care decision-making representation.
Formalizing Your Health Care Proxy Decision
To officially establish your health care proxy, you need to complete a durable power of attorney for health care form that is legally recognized in your state. You can typically find, download, and print free, state-specific advance directive forms online from various reputable sources, including legal aid websites and government health agencies. Depending on your state’s laws, you may need to have your form properly witnessed by a specified number of adults or officially notarized to be legally valid. Therefore, it is crucial to carefully read and follow the instructions provided with the form to ensure its legal enforceability.
To begin the process, you can [find advance directive forms specific to your state]([invalid URL removed]).
Post-Designation Steps for Your Health Care Proxy
Once you have formally named your health care proxy, taking the following steps is essential to ensure they are well-prepared to act on your behalf:
- Document Sharing: Provide your health care proxy with copies of the signed durable power of attorney for health care form, your living will (if you have one), and any other relevant documents that outline your health care wishes and values.
- Provider Information: Ensure your proxy has a comprehensive list of the names and contact information for all of your current health care providers, including your primary care physician and any specialists you see.
- Notification to Health Care Provider: Inform your primary health care provider about the identity of your health care proxy and ensure this information is documented in your medical records. Provide the provider with your proxy’s name and contact details.
It’s vital to maintain ongoing communication with your health care proxy over time. As your health care preferences, values, and decisions evolve, keep your proxy informed of these changes. Schedule regular conversations with your proxy, ideally at least once each year, to discuss your current wishes and ensure they remain aligned with your thinking. If you decide to change your health care proxy at any point, make sure to clearly notify both the previous proxy and your health care providers of this change, and update your legal documents accordingly.
Additional Resources
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For further information about choosing a health care proxy, please consult these organizations:
Administration for Community Living
202-401-4634
https://www.acl.gov
American Bar Association
800-285-2221
www.americanbar.org
CaringInfo (National Hospice and Palliative Care Organization)
800-658-8898
[email protected]
www.caringinfo.org
The Conversation Project
866-787-0831
https://theconversationproject.org
National POLST
202-780-8352
[email protected]
www.polst.org
OrganDonor.gov (Health Resources & Services Administration)
www.organdonor.gov
PREPARE for Your Care
[email protected]
https://prepareforyourcare.org
Department of Veterans Affairs
877-222-8387
www.va.gov/geriatrics
This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.
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