Guide for the Health Care Proxy

If you have been named in someone’s medical power of attorney, living will or other advance directives, then you may be referred to as the person’s proxy, agent, attorney-in-fact, surrogate, or representative. They all have the same responsibilities – you a have been named to make medical decisions for someone else. Sometimes, you may not be formally named in legal document but called upon to make decisions for a close family or friend who is in a medical crisis and cannot do so himself or herself.

Your responsibility as a health care proxy depends on the limitations of the person’s advance directives and the state or region law.

In most cases, you will have authority to make any and all decisions a patient would make for himself or herself, if able. This may include:

1. Receiving the same medical information the individual would receive.
2. Conferring with the medical team.
3. Reviewing the medical chart.
4. Asking questions and getting explanations.
5. Discussing treatment options.
6. Requesting consultations and second opinions.
7. Consenting to or refusing medical tests or treatments, including life-sustaining treatment.
8. Authorizing a transfer to another physician or institution, including another type of facility (such as an hospital or skilled nursing home).

Your responsibility begins the moment the person is not able to make decisions himself.

Making Health Decisions

No matter how tough or easy the medical decision is, the weight of making the decision for someone else is usually a tough one. There are usually opposing views for each situation. In the case of life-sustaining treatments for example, the proxy has to ponder the value of using new medical techniques versus protecting the loved one from unnecessary pain and suffering.

In these situations, the proxy can be in the middle of medical opinion, the family wishes and what he thinks the person may have wanted.

The best approach is to first understand the issues, look at the options and weigh in what the person would have wanted.

1. Find out the medical facts. This requires talking to the doctors and getting a complete picture of the situation. +Questions you can use:
   * What is the name of patient’s condition?
   * If you don’t know exactly what’s wrong, what are the possibilities?
   * Are tests needed to know more? Will the outcome of more testing make any difference in how you treat her, or in how she wants to be treated? (If not, why do the test?)
   * What is the purpose of each test? Do these tests have risks associated with them?
   * Is the information you need worth the risk of the test?
   * What is her condition doing to her now?
   * How do you explain her symptoms?
   * What usually happens with this disease?
   * What do you think now will be the likely course of this disease or condition?
   * How severe or advanced is her case?
   
   
2. Find out the options. Make sure the physician describes the risks and benefits of each option.
   
   You may want to ask:
   * How will this option make the patient improve or feel better?
   * What defines “success” for this option and how would the patient have defined success?
   * What is the success rate statistically?
   * Can this procedure be done on a trial basis and then reevaluated? What is an appropriate amount of time for a trial? Are you willing to stop it after an agreed-upon trial?
   * What will it mean to the patient’s quality of life?
   * If the patient was to die, how might it affect the circumstances of his death? (For example, will it likely require hospitalization instead of home care?)
   * What are the possible side effects?
   * What option do you recommend, and why?
   
   
3. What would the patient decide if he knew all the facts and options?
   You have three possible approaches to making the decision:
   * Use the patient’s preferences. If you know them, follow them.
   * Use substituted judgment. If you do not know the patient’s wishes for the specific decision at hand, but you have evidence of what he might want, you can try to figure out how he would decide. Here, you imagine yourself in the patient’s position. Consider his values, religious beliefs, past decisions, and past statements he has made then an option that the patient would probably have chosen, even if it is not what you would choose for yourself.
   * Use the patient’s best interest. If you have very little or no knowledge of what the patient would have wanted, then you and the doctors will have to make a decision based on what a reasonable person in the same situation would decide. In this case, you evaluate the benefits and burdens of the proposed treatment. For example, will the treatment cause the patient pain or suffering? Is it likely to make the patient better?

Related Articles

• Understanding Advance Directives, Living Wills and Powers of Attorney
• 10 Frequently Asked Questions about Power of Attorney
• Advance Care Planning Explained
• 8 Things a Proxy can do to Obtain Good Care for the Patient
• Conservatorship or Guardianship
• Elder Law Attorneys
• Financial Planners and What they Do