How To Be A Good Health Care Proxy

What Is A Health Care Proxy?

A Health Care Proxy may also be called a Health Care Power of Attorney, Agent, Representative, or Surrogate—whatever the title, the responsibilities are the same, and will depend on the wishes and Advance Directive of the person you're representing.

What Are My Duties As A Health Care Proxy?

In general, you will be in charge of making health care decisions on behalf of the person you're representing in case he or she is not able to make decisions for him or herself. In other words, you will observe and speak for the person you're representing in the way he or she would have wanted.

In your role as Health Care Proxy, you will have the right to make the following types of decisions:

• Choices about medical care, including medical tests, medicine, or surgery
• The right to request or decline life-support treatments
• Choices about pain management, including authorizing or refusing certain medication or procedures
• Choices about where the person will receive medical treatment, including the right to move the person to another facility, hospital, or state, or to a nursing home or hospice facility
• The option to take legal action on the person's behalf in order to advocate for his or her health care rights and wishes
• The right to apply for Medicare, Medicaid, or other programs or insurance benefits on the person's behalf

You may also be responsible for fundamentally managing the person's medical care. This may include:

• Learning about the person's medical condition and treatment options
• Communicating with the person's medical team, including asking questions about the person's condition, treatments, and treatment options
• Reviewing the person's medical chart
• Communicating with the person's family about his or her condition and treatment plan
• Accessing and approving release of the person's medical records
• Requesting and coordinating second opinions or outside medical care

When Does My Role As Health Care Proxy Go Into Effect?

Technically, your duties begin when the person you're representing loses his or her ability to make health care decisions on his or her own. (This will be determined by the person's doctor.) As soon as you're named as a Health Care Proxy, though, you can begin to get prepared.

How Should I Prepare For My Role As Health Care Proxy?

Your job is to advocate for the person you're representing—which means you need to know his or her decisions, beliefs, and values around life, end-of-life, and health care preferences. By learning about the person's wishes while he or she can still communicate with you, you can address any questions you might have and be prepared to responsibly care for the person if something should happen.

In order to understand the health care needs of the person you're representing, it might be a good idea to get a sense of the person's medical history and conditions. Some questions to ask are:

• Does the person have any ongoing medical issues, such as chronic conditions?
• Has the person had any major surgeries in the last 15 years?
• Does the person have any allergies (to medicines or to other things)?
• Is the person currently taking any medicines or receiving any medical treatments? What medicines or treatments and for what purposes?
• Are there any drugs or medical treatments that the person would prefer not to receive, and why?

If you can, have a conversation with the person to learn about how he or she would like to be treated at the end of life.

• Does the person care more about living as long as possible (even if that might mean some physical discomfort), or being as comfortable as possible (even if that might mean a shorter life)?
• Does the person want to be at home at the end of life, or would he or she prefer to be in a hospital or professional care setting?
• Does the person have religious or spiritual values that will affect the types of care or treatments he or she would like to receive?
• Are there specific life-support treatments that the person knows he or she would like to receive or would not like to receive?
• Would the person like to have a palliative care team or hospice team care for him or her at the end of life?
• Are there other wishes that should be observed as the person nears the end of life, such as calling a religious leader to come visit the person, having certain music playing, or having certain friends or family members in the room?

If you're both comfortable doing so, you might want to discuss possible scenarios and how the person would like to be treated in those scenarios, such as:

• How would the person want to be treated if he or she got an infection? Would the person want antibiotics, or not?
• How would the person want to be treated if he or she was diagnosed with a terminal illness? Would the person want every effort made to treat the disease, some effort made to treat the disease, or no effort made?
• How would the person want to be treated if he or she went into a coma? Would the person want to live in a coma for as long as possible, for a certain period of time, or not at all?
• How would the person want to be treated if he or she could no longer eat or drink on his or her own? Would the person want tube feeding, or not?

If the person you're representing has completed a Living Will, you may want to read that to get a sense of the types of treatment and care the person has specified that he or she wants and does not want.

Once The Proxy Goes Into Effect, What Should I Do?

As soon as a doctor has determined that the person you're representing has lost his or her ability to make health care decisions on his or her own, your role goes into effect. Depending on where you live and the type of communication you've had with the person, you may be close by and very well informed about the person's condition or you may be far away and unaware. No matter what, you should try and physically get to the place where the person is being treated, whether that's a hospital, a nursing home, or the person's own home. You will be able to do your job better if you can be close by. If you cannot get to the place where the person is, try and set up a phone call with the person's primary doctor or care coordinator.

There are two main things you'll need to figure out:

1. What is the person's medical situation? You should talk to the person's doctor to learn about the person's medical situation and learn the facts.

• Does the person's medical condition have a name? If not, what could could be some possible medical conditions that he or she has?
• Do tests need to be done in order to figure out what the person's condition is? Will the outcome of the tests make a difference in how the person is medically treated? If not, is there a reason for doing the tests?
• What are the symptoms that the person is experiencing or displaying? What is being done to alleviate those symptoms? Is this treatment consistent with the person's wishes?
• What is the usual course of this disease?
• Is a doctor who specializes in this disease involved in treating the person? If not, should a specialist be brought in?

2. What are the person's treatment options? Based on the facts of the person's medical situation, the doctor can talk with you about the options for treatment, the benefits and disadvantages of each treatment option, and the best choices considering the person's condition and wishes. For each treatment option, you might want to consider:

• What is the goal of this treatment?
• What is the likelihood that this treatment will be successful—and what does success mean? Does this definition of success correspond with the person's values?
• What are the side effects of this treatment?
• How will the treatment and the side effects affect the person's quality of life?
• If we try this treatment option and it doesn't seem to be working, how do we decide to stop trying?
• What would the person I'm representing want me to do in this situation?

Communicating With The Family

As the legally appointed Health Care Proxy, you have the right to make decisions on your own. However, you may want to consult with the person's family to get their perspective. Creating an environment of communication where people know what's going on and feel like a part of the process can be important, and can help build a strong sense of agreement at a difficult emotional time.