Choosing a Health Care Agent
What is a health care agent?
A health care agent is a person you choose in advance to make health care decisions for you in the event that you become unable to do so. A health care agent can make medical decisions on your behalf at the end of life or any other time you are unable to communicate, such as if you are severely injured in an accident or disabled by a stroke. A health care agent, also sometimes called a health care proxy or surrogate or attorney-in-fact, is designated in a document called a medical power of attorney.
State laws vary regarding the specific types of decisions health care agents can make. Generally, a health care agent can agree to or refuse treatment and can withdraw treatment on your behalf. Your health care agent can use the information in your living will (also called a treatment directive), statements made by you in the past, and what he or she knows about you personally to make these decisions. Some examples of decisions your health care agent might make for you include:
· Consent to surgery, including installation of a feeding tube, pacemaker, or other device
· Request that you undergo certain diagnostic tests, evaluations, or procedures
· Refuse to have you placed on life-support machines
· Request that you be taken off life support
How do I choose a health care agent?
Choose someone you trust. Your agent needs to be willing and able to make potentially difficult decisions about medical treatment for you. Discuss your desires, values, fears, and preferences about medical care in various situations. The more your agent knows about you and your values and wishes, the better able he or she will be to make the kinds of decisions you would make for yourself if you were able.
A legal form, usually called a medical power of attorney (but which may be called by other names in some states), is used for documenting your choice of a health care agent. The form often allows you to designate additional "backup" agents in case your first designee is unavailable. This form is usually available through your state's bar association or office for the aging; law offices and hospitals also will have these forms available or can direct you where to find them. You must sign the form to make it valid. Some states require the form to be notarized (witnessed by a notary public) and/or signed by at least two other witnesses.
Be sure to tell your family members and doctors whom you have selected as your health care agent and why. Also, make sure to keep this legal form in a safe place, and have a copy inserted into your medical records as well.
Who will make decisions for me if I don't have a health care agent?
By appointing a health care agent, you are clearly stating who has the authority to make health decisions on your behalf. If you do not have a health care agent or a living will, your family members may disagree about the type of medical care you should receive if you are ever in a situation where you cannot communicate on your own behalf. Depending on the state in which you live, decisions about your medical care may be made by doctors, hospital administrators, or judges. Completing a living will and choosing a health care agent can greatly reduce confusion and anxiety in emergency situations, and will help facilitate important decisions during a stressful time.
Why a Health Care Agent Is Needed
Someone will have to make medical decisions for you if become unable to communicate or lose decision-making abilities. By selecting a health care agent in advance, you grant the person you want to make these decisions the legal right to do so in a document called a medical power of attorney. This helps avoid uncertainty, conflict, and stress for your loved ones during a time that is likely to already be difficult for them. Also, it ensures that you will have an advocate to help others understand your wishes and preferences. Ideally, you will also create a living will that outlines the basic types of care you would want under a variety of situations. Having this document can help your health care agent, doctors, and family members understand your desires more completely. However, it cannot cover all conceivable situations that might occur, which is why it is so important and helpful to designate a health care agent in advance. He or she can talk to your doctors about care options, weigh the risks and benefits, and make decisions based on the specific situation. The health care agent and living will complement each other so you can be assured that your medical care matches your preferences as closely as possible.
A health care agent can also have more credibility than a nondesignated family member or friend in seeking a second opinion, requesting diagnostic tests or procedures, or talking to hospital administrators about your care. This can become especially important if your agent feels decisions about your health care are not being made in the way that you would wish.
By appointing a health care agent, you are clearly designating a specific person who understands your wishes and who you want to make health decisions on your behalf.
A medical power of attorney and a living will are types of advance directives. For more information about these documents, see Writing an Advance Directive.
Choosing a Health Care Agent
Choosing a health care agent is an important decision that will help ensure that your wishes for medical care will be respected if you are not able to communciate for yourself, for any reason. The following steps will help you choose and then prepare your agent to speak on your behalf.
- Choose someone you trust. Select someone who knows you well and could intelligently apply this knowledge in different circumstances. Also, consider whether the person could handle the stress and emotional turmoil that can go along with having to make these kinds of important decisions on behalf of someone else. Be sure he or she is mature and strong enough to handle this responsibility. It may help to review some basic considerations for choosing a health care agent.
- Use the checklist for writing an advance directive, and take time to carefully consider medical issues and the types of care available in different situations. Talk to your agent and your family about your values and preferences for medical treatment.
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- Make sure your health care agent knows what you consider to be an acceptable quality of life and how high the likelihood of a full or acceptable recovery should be before you would accept treatment. You do not want to limit your agent’s ability to make decisions, but he or she should know what is important to you.
- Do not assume that someone close to you, such as a child or spouse, knows what you would want. Your agent may not know about or share your preferences, so it is very important that you talk openly and clearly about your wishes.
- It is not possible to discuss every possible situation that might arise in which your agent may need to make a decision for you. However, if you talk with your health care agent about what is most important to you, your agent will be better able to make the kinds of decisions that you would make if you were able.
- Complete the necessary forms to appoint your agent.
- All states have a document you can use to appoint a health care agent. This form is usually called a medical power of attorney or durable power of attorney for health care. You do not need a lawyer or attorney to complete this form, but it usually must be witnessed by someone other than you and your agent. Witnessing requirements vary by state. To obtain copies of the forms for your state and instructions for completing the forms, contact the Last Acts Partnership (1-800-989-WILL [9455]).
- Read the forms carefully. Some states may restrict the types of decisions that a health care agent can make or may limit the health care agent’s authority to only those decisions written in your living will.
- Depending on the laws in your state, you may wish to involve your health care agent as you write your living will so that your agent fully understands your wishes.
- Tell your family, your doctors, and anyone else who might be involved in your medical care who your agent is and how to contact your agent.
- Keep copies of your living will and health care agent documents in a safe but easy-to-access place where others can find them.
- Give copies of these documents to your doctor, your agent, your family members, and anyone else who may need them.
Where to Go From Here
Talk with your family about whom you have selected as your health care agent and explain the reasons why. Try to openly discuss the types of medical care you would or would not want under various circumstances. Make it an ongoing conversation; you may decide to first introduce the idea by bringing up the fact that you have selected an agent. If your family has difficulty discussing the issue, provide more information gradually.
Make sure your advance directive forms are kept in a safe but accessible place, which is known to your family, loved ones, and your physicians. In addition, give copies to your agent, lawyer, doctors, family members, and anyone else you think should have one. Do not keep them in a safe deposit box because if you are not able to communicate, your family may not know how to retrieve them. Similarly, don't rely on your lawyer to be able to provide the documents when they are needed. Your family may not know whom to contact, or know how to reach them in an emergency situation.
You can make changes to any advance directive at any time. This includes changing your health care agent. You should fill out a new form for any except very minor changes, such as a new phone number or address.
Communicate with your health care agent. If you change your mind about medical care matters and make a new living will, keep your health care agent up to date.
For more information on living wills and medical powers of attorney, see Writing an Advance Directive. For more information on other end-of-life issues, see Hospice Care and Care at the End of Life.
Other Places to Get Help
Organizations
Aging With Dignity
P.O. Box 1661
Tallahassee, FL 32302
Phone: (888) 5-WISHES
E-mail: fivewishes@agingwithdignity.org
Aging with Dignity is a private, non-profit organization best known for its Five Wishes advance directive, which helps individuals and families better plan for and receive the kind of care they want during times of serious illness. Five Wishes is a document that helps you express how you want to be treated if you are seriously ill and unable to speak for yourself. All of a person’s needs are addressed: medical, personal, emotional, and spiritual.
Caring Connections
1700 Diagonal Road
Suite 625
Alexandria, VA 22314
Phone: (800) 658-8898, (703) 837-1500
Fax: (703) 837-1233
E-mail: caringinfo@nhpco.org
Caring Connections, a program of the National Hospice and Palliative Care Organization (NHPCO), seeks to improve care at the end of life. Caring Connections provides free resources, including educational brochures, advance directives and hospice information, and a toll-free helpline to people looking for quality end-of-life information.
National Hospice and Palliative Care Organization
1700 Diagonal Road
Suite 625
Alexandria, VA 22314
Phone: (800) 658-8898, (703) 837-1500
Fax: (703) 837-1233
The National Hospice and Palliative Care Organization (NHPCO) offers information on local hospice and palliative care programs across America. NHPCO is committed to improving end-of-life care and expanding access to hospice care with the goal of improving quality of life for dying people and their loved ones.
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