No one likes to think about being unable to make your own decisions, especially when it comes to medical choices. But the older you get, the more likely it is that there may be a situation when someone else will need to step in when you can’t speak for yourself, such as a being in a coma, having a terminal illness, or an unexpected occurrence while you’re under anesthesia. The best way to ensure that your health care providers turn to the person you have chosen to make decisions for you is to establish a health care proxy.
Your proxy (or agent) is named in a form you complete and give to your primary care provider. Health care proxy forms are readily available online or from your doctor — all that’s needed is two witnesses to your signature; a lawyer is not required.
Health care proxies are a type of advance directive: written instructions outlining your health care wishes. Another type of advance directive is a living will: a document written at a single point in time that states what interventions you want and which you don’t in case of a health crisis. A health care proxy can be more flexible, since he or she knows you well and applies that understanding to your condition as it may change. You can help your proxy by talking to them about your wishes, such as, “It’s most important to me that any time I have is meaningful and productive,” which will help them make the best decisions for you. He or she can talk with your doctors, view your medical records and consent to tests, treatments and procedures. Your proxy only speaks on your behalf if you are unable to do so.
Deciding who to ask as your proxy means thinking about who will be willing to respect your wishes, even if those wishes are different from what he or she would choose. Additionally, consider if the person you have in mind is so emotionally connected to you he or she would have a hard time making decisions. Is the person willing to ask questions or ask for clarification? Will he or she be able to stand up to medical staff if necessary? It is helpful to decide on a secondary proxy if the first agent is unreachable. Also, if you’re married, your spouse does not have to be your health care proxy. If you do not have a proxy and someone needs to make decisions for you, New York law requires the following people in this order would become your proxy, if they are available: your spouse or life partner, legal guardian, adult children, parent, sibling, close friend or relative. If they have not had the opportunity to speak with you about your wishes, they will need to do their best in deciding what they think you would want.
There are some limitations — these vary by state, so be sure to check that the person you select is legally acceptable. For example, a member of your current health care team may not serve as your health care proxy, and some states have minimum age requirements. In New York, a proxy must be a competent adult older than 18.
Once you’ve asked your proxy and received a “yes,” be sure to let your family know so there are no surprises down the road. For your peace of mind, it’s helpful to know that no one can override your selected proxy — for example, adult children can’t show up and start making care decisions if you’ve selected a long-time friend as your proxy. Your proxy doesn’t have to be local, either — he or she can be contacted by phone if needed.
After you fill out your paperwork, keep a copy, give one to your proxy, and be sure your primary care provider has your proxy’s name and contact information in your patient record. Even if you don’t have a relative, friend or neighbor you can ask, it’s smart to fill out the proxy paperwork anyway, designating what interventions or treatments you’re comfortable with. This helps your medical team understand what’s important to you if you’re unable to speak for yourself.
It’s important to note that a health care proxy is not the same as legal power of attorney, which allows a designated person to sign checks and documents, make real estate transactions, or access bank accounts. Power of attorney is a separate permission, and can be durable (used over time in many situations) or limited (granted only for a single real estate transaction, for example).
For more information, visit www.nyuhs.org/patients-visitors/advanced-directives/.
Lorraine Carrillo is social services program manager at Delaware Valley Hospital in Walton.