Setting Up a Healthcare Proxy

Rich, a 70-year-old man in relatively good health, was scheduled for a hip replacement surgery in two months. Before the procedure, he scheduled a physical with his primary care doctor to get some bloodwork done and make sure everything was normal.

While discussing the surgery, Rich’s doctor asked if he had lined up a healthcare proxy ahead of the surgery. Rich said he had not and asked his doctor about the process.

Rich’s doctor explained the proxy as a way of having someone make healthcare choices for you if you are alive but incapacitated – meaning you are unable to make decisions for yourself due to a medical condition or illness. For example, the doctor said, if Rich had an unforeseen complication during his surgery, he would have someone who he had already chosen to advocate for him on his behalf.

What is a health care proxy?

A health care proxy is a type of document called an advance healthcare directive. You choose a specific person called an agent to make health-related decisions on your behalf in case you are incapacitated.

On the document, you will determine how much or how little flexibility the agent will have to carry out those decisions.

The only time an agent will be given the authority to make those decisions is after a qualified physician determines you are incapacitated. Otherwise, the doctors will continue to have you make your own decisions.

Role of the proxy

If the agent is asked to make decisions, they will be asked to respond about your wishes. At that time, what does your agent believe you would decide if you could speak for yourself?

Some of the decisions your agent could need to make include:

• Agreeing to or declining surgery or other procedures
• Continuing aggressive care or transitioning toward a comfort approach
• Deciding where you would want to receive care after hospitalization
• Balancing the burden of continued treatments vs pain control.
• Setting up or ending artificial nutrition or hydration via feeding tube or IV line

“When selecting someone as your proxy, be sure they are someone who knows your personal beliefs on philosophical and spiritual matters,” Dr. Ryan said. “The idea of a proxy is someone who would speak on your behalf as you would.”

Differences between healthcare proxy, living will, and power of attorney

It can be confusing to understand the difference between certain types of advance healthcare directives such as a healthcare proxy and a living will, and a legal directive such as power of attorney.

A healthcare proxy establishes an agent who will make health-related decisions as if they were you. In general, the responsibility is broad, but only involves your health care. It can require them to make several decisions over time, as your condition changes. In the end, you trust your agent to speak for you.

A living will is a written document that provides specific guidance for specific healthcare situations. For example, you might write if you are in a permanent coma, you do not want to have an artificial nutrition tube inserted. These decisions can be as specific as you would like. They can help to remove the burden family members might feel about making decisions when you cannot.

“Both healthcare proxies and living wills are important to have in case of a serious life-threatening health situation,” Dr. Ryan said. “Having a healthcare proxy allows for more flexibility. A living will gives you the confidence that you have laid out your wishes for medical care. That being said, there is no reason why a person can’t have specific instructions included on their healthcare proxy form or even do both.”

For non-health care decisions, you might identify a person to be your power of attorney or POA. The POA is a separate role with discretion on financial matters. The same person can be both your health care proxy and power of attorney. It’s your choice.

How to set up a proxy

Before you begin the process of establishing a healthcare proxy, it is important to have an open and honest conversation with the person who you are choosing.

Rich is a widower with two sons. Both sons live out of town. Rich has a friend, Dave, whom he has known since high school. Recently, Rich and Dave have spent time talking about Dave’s parents and their declining health.

After having these conversations with Dave, Rich feels that Dave would be a good person to ask to be his proxy.

Some specifics to know:

• Your agent must be 18 years old or older. As mentioned by Dr. Ryan, your agent should understand how you feel about quality of life, how far you would want doctors to go treating you, and what you want your care to look like at end of life.
• The document needs to be witnessed and signed by two people or notarized by one person. If you decide to have it signed by two people, your agent cannot be one of them.

“You do not need an attorney to set up a healthcare proxy,” Dr. Ryan said. “Once you finalize the form with your witness signatures or notary signature, you are set. Be sure to send copies to your doctor and the person you have chosen as your agent.”

Rich left his doctor’s office with a healthcare proxy form and called Dave, who agreed to be his agent. Rich completed the form that night.

Even though he expected the surgery to go as planned, Rich felt better knowing he had Dave as his agent.