Why all adults need a health care proxy

health care proxy

By Laura Carman, M.D.
Hallmark Health Medical Associates

health care proxy

Have you named a health care proxy to speak for your medical care if you are unable to do so?

One of my patients who was in her 70s had a large tumor in her chest. It was almost surely cancer, but we weren’t 100 percent certain.

She was becoming very short of breath and was getting confused. We had a decision to make:

  • Put her on a respirator, get a biopsy of the tumor, and start radiation to shrink the tumor to hopefully improve her breathing, or
  • Make her comfortable, but provide no other treatment, because her suspected cancer was likely not treatable or curable.

All of her children were there, and during a family conference, I asked, “Does anyone know what your mother would have wanted under the circumstances?”

No one said anything.

Finally, her daughter-in-law spoke up. The daughter-in-law’s husband had recently died after an illness. He had wanted all life-saving procedures performed. During that time, my patient had confided in her daughter-in-law, “He wanted everything done, and that’s fine for him, but if it were me, I wouldn’t want anything done.”

This type of information is so important. Based on the comment my patient had made to her daughter-in-law, the family agreed not to pursue heroic measures and asked us instead to focus on making her comfortable.

But imagine if the comment had not been made. Imagine if the woman’s family couldn’t agree on what to do. Thankfully, we have a way to prevent this kind of dilemma: a health care proxy.

Everyone needs a health care proxy, not just the elderly. Anybody can be in a situation where they’re temporarily unable to speak for themselves. By naming someone in a health care proxy to speak for you and by informing them of your wishes, you relieve the potential burden on others.

What is a health care proxy?

A health care proxy is a legal document that lists who you have chosen to make medical decisions for you if you are not able to speak directly to the physicians caring for you. We provide the free form in our office.

For example, if you are in a car accident and need an emergency surgery, the doctors are going to want someone to sign a form giving permission for the surgery. If you can’t give permission because you’re unconscious, they would want a family member or the person listed in the health care proxy to give permission.

A health care proxy is important to have, even if you have immediate family members nearby. Sometimes decisions need to be made quickly, and if several family members are weighing in, it could delay care.

The health care proxy form is easy to fill out. You will need to have two witnesses sign it, not including you or the person you have appointed. You can have the paperwork prepared by an attorney, fill it out in our office, or download it online. If you do it in our office, we provide the witnesses.

Once you’ve filled out the form, give one to your doctor and one to the person named in your health care proxy, and keep one in your house. You can change the designated person at any time, just like you would change a will.

You also can decide to list an alternate person on the form, just in case the primary person can’t make the decision or is unreachable when needed.

The proxy document gives the person to make medical decisions on your behalf, but you are still responsible for explaining your medical wishes to them before an incident occurs. The document does not outline any specific medical actions.

How to pick the person named in your health care proxy

A health care proxy should name only one person and an optional alternate, not a group of people. It’s often a family member or a close friend, but it doesn’t have to be. This person can gather feedback from other family members, but ultimately the health care proxy is the sole decision maker.

When you’re selecting a health care proxy, keep these things in mind:

  • Select someone who is willing and able to make decisions about your health. Some people are not natural decision makers, so that’s something to consider. Think about family dynamics, and who could make an effective decision.
  • Let the person know that they are listed in your health care proxy.
  • Give the person named in your health care proxy as much information as you can about your medical wishes.

Parents who have lost their spouse often choose to name one of their children in their health care proxy. If you have more than one child, this can be a difficult decision. Some default to the oldest child, but I recommend choosing the person who is best equipped to make a decision during challenging circumstances. Who could make the decision to terminate life support, for example, if that is your wish?

What factors should I consider about my medical care?

You may already know what’s important to you as far as medical treatment goes. If you don’t, there are products available that provide checklists and suggestions to consider. One I recommend is called Five Wishes.

In your conversation with the person named in your health care proxy, you should consider discussing what you would want if:

  • You were terminally ill and not expected to recover.
  • You suffered brain damage or were in a coma and not expected to improve.
  • You needed life support, such as a respirator or a feeding tube.
  • You couldn’t live on your own and would be dependent on other people.

I’m proactive about this issue with my patients. I often bring it up during their annual visits or other medical visits. If they tell me some of their specific wishes, I put that information in their chart so it’s available to family and other physicians.

If you have specific medical wishes, but are uncomfortable talking about this topic with your family, I encourage you to talk with your doctor. It can save your family from a lot of anguish down the road.

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