What to Know About Being a Health Care Proxy

When you assume the role of the health care proxy of a loved one, you make crucial medical decisions on their behalf. If your loved one becomes incapacitated and cannot communicate with health care providers, you are responsible for ensuring health care providers respect their preferences for care.

If you are a health care proxy, your role is to protect your loved one’s interests when they are vulnerable. Health care proxies have an essential, yet challenging role, as medical decisions can significantly impact patient outcomes.

What Is a Health Care Proxy?

A health care proxy is a person who makes health care decisions for someone else – that is, by proxy. These decision-makers include health care agents, who the patient appoints via power of attorney, guardians authorized by the court, or legal surrogates. Legal surrogates are close family members called upon to make decisions when the patient has no agent or guardian.

Understanding the Role

The role of health care proxy includes:

• Reviewing and staying informed about your loved one’s medical information.
• Consulting with the health care team and asking questions about your loved one’s status and treatment.
• Consenting to and declining medical tests and treatments on their behalf.
• Deciding where your loved one receives care, including hospitals, assisted living, and nursing care.
• Facilitating communication between your loved one and doctors and nurses to the extent that your loved one can communicate.
• Making decisions involving your loved one’s finances and insurance.

Depending on the circumstances, you might know in advance that you will serve as a health care proxy, or you might take on the role unexpectedly. Should you have time to prepare for your role, keep several things in mind:

• Talk with the person you represent. Understanding their values, beliefs, and preferences regarding medical treatment will help you make decisions consistent with their wishes.
• Become familiar with your loved one’s medical history and health care team.
• Review relevant legal documents. Your loved one may have a power of attorney designating you as the health care agent and a living will describing their end-of-life wishes.

Communicating With the Person You’re Representing

When you assume the role of surrogate decision-maker, it is crucial to understand the patient’s wishes and values. Since you do not know how their condition will change, it is a good idea to have conversations about their medical preferences early and often.

Consider speaking with their other close family members if your loved one cannot communicate. Although you are the final decision maker, those close to the patient may be able to provide additional information.

Making Health Care Decisions as a Medical Proxy

When you make medical decisions for an individual, consider taking the following steps.

• Understand the medical facts. Speak to health care providers and review records to get a complete picture. Good practices include bringing a list of questions and taking notes when you meet with the doctor as well as compiling a list of all medications.
• Assess the options. Ask health care providers about the risks and potential benefits of each choice.
• Identify what the patient would want. Your role is to follow the individual’s wishes, even if they differ from what you would choose for yourself. Should conflicts between family members and health care providers arise, make choices consistent with the patient’s wishes.
• If you cannot determine what the patient would want, do what is in their best interests.

End-of-Life Decision-Making by Proxy

Health care proxies are often called upon to make end-of-life decisions. For instance, doctors might ask you to decide whether to prolong your loved one’s life or allow them to pass naturally. You might be responsible for consenting on the patient’s behalf to medical research or experimental treatments.

As the health care proxy, you have an essential role in the decision-making process. When you make end-of-life decisions for the patient, following their wishes is paramount.

Refer to any advance directives they may have. Perhaps they had a living will expressing their desire to either prolong life or provide noninvasive care to keep them comfortable as they pass. Their health care power of attorney might also include end-of-life and funeral instructions.

Sometimes, you might have to decide whether the patient participates in medical research. It is essential to understand the purpose of the study, as well as the risks and potential benefits. Research participation is optional. You can decline if it would not benefit your loved one.

Self-Care for Health Care Proxies

Being a health care decision-maker can be stressful, and you could experience grief as the patient’s health declines. Just as you care for your loved one, you must care for yourself to avoid burning out.

Strategies for coping with stress and emotions that may arise in your role as a health care proxy include getting enough sleep, exercising, practicing meditation, and seeking mental health counseling.

Seek Additional Support

Consulting with a professional can also help you understand your role. You may benefit from checking out the American Bar Association Commission on Law and Aging’s "how-to” guide on serving as a health care proxy. Consider contacting a geriatric care manager and an estate planning attorney near you for additional support.