No matter one’s age or health status, every adult should name a health care proxy.
No one wants to put their loved ones in the position of having to make a painful decision, and perhaps that’s why a majority of Americans haven’t named a health care proxy. Even though having the conversation can be difficult, everyone 18 and older should complete an advance directive.
Advance Directives: Living Will vs. Health Care Proxy
Advance directives are legal documents that communicate your wishes for your own healthcare in the event that you are unable to do so yourself. The two most common advance directives are a living will and a health care proxy form. A living will lays out your wishes for your medical care. A living will can detail a variety of medical situations and how you would want to be treated in each instance: for example, tube feeding, medical ventilation, medication, palliative care, and emergency care including CPR.
A health care proxy form (also called a durable power of attorney for health care) designates a person who may make medical decisions on your behalf should you be unable to make decisions for yourself. Depending on the state where you live, this person may be called a health care proxy, surrogate, agent, or representative. Sometimes this person is also called a medical power of attorney or attorney-in-fact. It’s important to keep in mind that this person doesn’t have the power to make financial decisions on your behalf.
Having a combined advance directive–that is, both a living will and a health care proxy–sets the stage for a more peaceful end-of-life experience for the person and their loved ones. With a living will, family members will never come to the point of having to make a painful decision, wondering if they chose correctly what their loved one would have wanted. The decision is already made. Advance directives also enable better care on the part of the healthcare team and support palliative care decisions.
Choosing a Health Care Proxy
The Conversation Project offers a helpful resource for navigating the process of choosing a health care proxy. Usually, people choose their spouse, an adult child, a parent, or a sibling. But a health care proxy doesn’t have to be family: this can be any trusted person who can be reached in case of an emergency and understands the values of the person for whom they may be making a life-or-death decision.
According to the Conversation Project, while you may have the option to name two health care proxies, it’s considered better to choose just one. In fact, some states dictate that individuals can only have one health care proxy, and it makes sense: putting two people in charge, especially within the same family, especially during an extremely difficult time in their lives, invites interpersonal and possibly legal disputes. Plus, even minor confusion about the wishes of different acting proxies can prevent the medical team from providing timely and appropriate care.
While you should only ever name one health care proxy, it’s smart to designate an alternate proxy in case your primary health care proxy cannot fulfill their duties. Some other factors to keep in mind: your proxy need not live locally, because they can make decisions over the phone. Current members of your care team may not be named as your proxy.
If you don’t choose your own proxy, the law will choose one for you, and in most cases that person will be your spouse, parent, adult child, or close family member. Depending on the state and the person’s close living family, the law may select a professional guardian. A guardian would do their best to make decisions according to the person’s wishes, without having met them.
You can choose the same person to be your financial power of attorney and your power of attorney for health care, but these are distinct roles. And while you can pay someone to be your health care proxy, it’s not as common as hiring an expert to be a financial power of attorney. When selecting a health care proxy, no expertise is as important as their knowledge of you as a person, and your conviction that they have your best interests at heart.
Being a Health Care Proxy
Choosing a health care proxy can be an emotional challenge, and the same goes for fulfilling the role of a proxy. The Conversation Project offers another guide for people who find themselves in the position of a health care agent.
The first reminder in the guide is: “There is no perfect proxy.” Don’t let fear of making a mistake keep you from taking on this important role for a loved one. The key qualities in a proxy are a knowledge of the person and their values, and an ability to give voice to what you understand to be the person’s values in a difficult situation.
If someone asks you to serve as their health care proxy, be sure to have a conversation together about what the role means to each of you. (The Conversation Project guides will support you.) When you’re ready to fill out the legal forms, you don’t need a lawyer’s help. The National Institute on Aging lists various sources when you can find the forms you need for free, including specific forms for veterans.
Many health care proxies never need to make a decision on their loved one’s behalf. But for those who do, having discussed and prepared beforehand eases the experience. Serving as a health care proxy is a gift we give to those we love.
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