Health care proxy
Definition
A health care proxy, or health care proxy form, is a legal document that allows a person to choose someone to make medical decisions on their behalf when they are unable to do so. In some states the person who is authorized may be called a proxy; in others the person may be called an agent.
Description
A health care proxy form is part of a set of legal documents that allows a person to appoint someone to make medical decisions for them if or when they cannot act on their own behalf, and to make sure that health care professionals follow their wishes regarding specific medical treatments at the end of life. These documents are referred to as advance directives. The document naming the person appointed to make the decisions is called a health care proxy. The document that lists acceptable and unacceptable measures of artificial life support is called a living will . Most states have passed laws that authorize people to draw up living wills, but it is important to get specific information about the laws in one's own state.
Any competent adult can appoint a health care proxy or agent. It is not necessary to hire a lawyer to draw up or validate the form; most states, however, require two adult witnesses to sign a proxy form. Many hospitals provide proxy forms on request.
It is important to have a health care proxy in order to be able to choose the person who will be making medical decisions on one's behalf. In addition to naming the specific person who will make those decisions, one should think about what life-sustaining treatments one would be willing to undergo in the event of a medical emergency or terminal illness.
A health care proxy form does not deprive a person of the right to make decisions about medical treatment as long as he or she is able to do so. It is put into effect only when the patient's health care team determines that the patient is unable to make decisions on his or her own. For example, a person may be in a coma following an automobile accident. The physician would document in the patient's medical record that the patient is unable to make his or her own medical decisions; the circumstances that led to the patient's present condition; the nature of the disease or injury; and the expected length of the patient's incapacitation.
The person named as proxy makes health care decisions only as long as the patient is unable to make them for him- or herself. If the person regains the ability to make his or her own decisions, the proxy will no longer make them. If the incapacitation is permanent, the proxy will continue to make health care decisions on the patient's behalf as long as the patient is alive, or until the proxy is no longer able to carry the responsibility.
Any trusted adult can be named as a health care proxy. Most married people name their spouse, but it is not necessary to do so. In addition, it is important to select an alternate proxy, in the event that the person first named is unable to fulfill the responsibility. For example, if the spouse has been named as proxy, and both members of the couple were incapacitated in a house fire, then someone else should be empowered to act on their behalf. A married couple does not need to name the same individual as a proxy or as the alternate. It is best to choose someone who lives close enough to carry out the responsibilities of a proxy without having to travel across state lines.
One should consider whether a potential proxy will be able to ask the necessary questions of medical personnel in order to obtain information needed to make a decision. It is important to discuss with the proxy his or her own value system, and whether he or she could make a decision for someone else that he or she would not make for him- or herself. It is a good idea to carry the name and contact information of the proxy in one's wallet in the event of an emergency or sudden incapacitation.
The purpose of a living will is to give specific instructions about emergency or end-of-life health care. In some states a living will may be part of the health care proxy document. But because it is impossible to plan for all possible situations, the health care proxy can interpret one's wishes to members of the health care team and make decisions that one could not foresee at the time of making a living will. This is why it is important for the proxy to understand one's value system, so that the proxy can use his or her judgment as to what one would want. The proxy should be given a written copy of all advance directives. Even if a living will is not legal in the state in which one resides, writing such a will is an opportunity to think through one's beliefs and health care preferences. The proxy or agent can then can use the living will as a guide in making health care decisions as need arises.
Completing a health care proxy form and living will is useful because it helps one to think through one's value system and one's definition of quality of life. Some areas to consider are:
- What makes my life meaningful?
- What religious or personal beliefs do I hold that affect my health care decisions?
- Do I want my proxy to make health care decisions on his or her own, or are there other people I would want him or her to consult? If so, who are these people? Is there anyone who should not be consulted?
- Who besides myself will be affected by these decisions? Are they aware of my value system? Would they try to interfere with the proxy's decisions?
- What do I want to do about organ donation?
- Have I informed my physician of my wishes?
Appointing a health care proxy is not an irrevocable decision. One can change or revoke the proxy at any time, usually by filling out a new form. In some states, one can specify that the health care proxy will expire on a certain date or if certain events occur. If one has named one's spouse as an agent, the proxy is no longer in effect in the event of separation or divorce. People who want a former spouse to continue as their agent must complete a new proxy form.
In addition to keeping a copy of the proxy form in one's own file of important documents, one should give copies to the proxy, the alternate, and one's physicians.
Resources
organizations
American Association of Retired Persons (AARP). 601 E. Street NW, Washington, DC 20049. (800) 424-3410. <www.aarp.org>.
American Medical Association. 515 N. State Street, Chicago, IL 60610. (312) 464-5000. <www.ama-assn.org>.
National Cancer Institute (NCI). NCI Public Inquiries Office, Suite 3036A, 6116 Executive Boulevard, MSC8322 Bethesda, MD 20892-8322. (800) 422-6237. <www.cancer.gov>.
National Library of Medicine. <www.nlm.nih.gov>.
Partnership for Caring. 1620 Eye Street NW, Suite 202, Washington, DC 20006. (202) 296-8071. <www.partnershipforcaring.org>.
Esther Csapo Rastegari, R.N., B.S.N., Ed.M.
