Choosing a Health Care Agent

Topic Overview

What is a health care agent?

A health care agent is a person you choose in advance to make health care decisions for you in the event that you become unable to do so. A health care agent can help make medical decisions on your behalf at the end of life or any other time you are not able to communicate, such as if you are severely injured in an accident. A health care agent also may be called a health care proxy or surrogate or an attorney-in-fact.

State laws vary regarding the specific types of decisions health care agents can make. In general, a health care agent can agree to or refuse treatment and can withdraw treatment on your behalf. Your health care agent can use the information in your living will(also called a treatment directive), statements made by you in the past, and what he or she knows about you personally to make these decisions. For example, your agent can consent to surgery, refuse to have you placed on life-support machines, or request that you be taken off life support.

How do I choose a health care agent?

Choose someone you trust. Your agent needs to be willing and able to make potentially difficult decisions about medical treatment for you. Discuss your desires, values, fears, and preferences about medical care in various situations. The more your agent knows about you and your values, the more likely he or she will be to make the kinds of decisions you would make if you were able.

Where can I get the form I need to name my health care agent?

A legal form, usually called a medical power of attorney (but it may be called by other names in some states), is used for documenting your choice of a health care agent. This form is usually available through your state's bar association or office for the aging. Law offices and hospitals also have these forms or can direct you to where to find them. You can also get copies of the forms for your state from Caring Connections at its website or by phone: www.caringinfo.org or 1-800-658-8898.

You must sign the form to make it valid. Some states require the form to be notarized (witnessed by a notary public) and signed by at least two witnesses. A medical power of attorney and a living will are types of advance directives. Be sure to tell your family members and doctors whom you have selected as your health care agent.

Who will make decisions for me if I don't have a health care agent?

By appointing a health care agent, you are clearly stating who has the authority to make health decisions on your behalf. If you do not have a health care agent or a living will, your family members may disagree about the type of medical care you should receive if you are ever in a situation where you cannot communicate. Depending on the state in which you live, decisions about your medical care may be made by doctors, hospital administrators, or judges. Completing a living will and choosing a health care agent can help your family and friends make decisions during a stressful time.

When a Health Care Agent Is Needed

Someone will have to make medical decisions for you if you become unable to communicate or lose decision-making abilities. By selecting a health care agent in advance, you grant the person you want to make these decisions the legal right to do so. This helps avoid uncertainty, conflict, and stress for your loved ones during a time that is likely to already be difficult for them. Also, it ensures that you will have an advocate to help others understand your preferences. The legal form that states your choice of a health care agent is usually called a medical power of attorney or a durable power of attorney for health care. But it may be called by other names in some states.

Ideally, you will also create a living will that outlines the basic types of care you would want under a variety of situations. Having this document can help your health care agent, doctors, and family members understand your desires more completely. But it cannot cover all possible situations that might occur. A health care agent becomes especially valuable if your condition changes. He or she can talk to your doctors about care options, weigh the risks and benefits, and make decisions based on the specific situation. The health care agent and living will complement each other so you can be assured that your medical care matches your preferences as closely as possible.

A health care agent can also have more credibility in seeking a second opinion or when talking to hospital administrators about your care. This can become especially important if your agent feels that decisions about your health care are not being made in the way that you would wish.

If you do not have a health care agent or a living will, decisions about your medical care may be made by family members (who may find it difficult to be in such a position or who may disagree with each other), doctors, hospital administrators, or judges. By appointing a health care agent, you are clearly stating who you think understands your wishes best and who you want to make health decisions on your behalf.

A medical power of attorney and a living will are types of advance directives. For more information about these documents, see the topic Writing an Advance Directive.

Choosing a Health Care Agent

Choosing a health care agent is an important decision that will help ensure that your wishes for medical care will be respected if you are not able to speak for yourself. The following steps will help you choose and then prepare your agent for speaking on your behalf.

1. Choose someone you trust to be your agent. Think about who in your life knows you well and who could intelligently apply this knowledge in different circumstances. Also, consider whether the person could handle the stress and emotional turmoil that can go along with these important decisions. Be sure he or she could handle this responsibility. It may help to review some basic considerations for choosing a health care agent.
2. See what things to include in your advance directive. And take time to carefully consider medical issues and the types of care available in different situations. Talk to your agent about your values and preferences for medical treatment.
   • Make sure your health care agent knows what you consider to be an acceptable quality of life and how high the likelihood of a full or acceptable recovery should be before you would accept treatment. You do not want to limit your agent's ability to make decisions, but he or she should know what is important to you.
   • Do not assume that someone close to you, such as a child or spouse, knows what you would want. Your agent may not know about or share your preferences, so it is very important that you talk openly about your wishes.
   • It is not possible to discuss every possible situation that might arise in which your agent may need to make a decision for you. But if you talk with your health care agent about what is important to you, your agent will be better able to make the kinds of decisions that you would make if you were able.
3. Complete the necessary forms to appoint your agent.
   • All states have a document you can use to appoint a health care agent. This form is usually called a medical power of attorney or durable power of attorney for health care. You do not need a lawyer or attorney to complete this form, but it must be witnessed by someone other than you and your agent. Witnessing requirements vary by state. This form is available through your state's bar association or office for the aging. Law offices and hospitals also have these forms or can direct you to where to find them. You can also get copies of the forms for your state and instructions for completing the forms by contacting Caring Connections (www.caringinfo.org or 1-800-658-8898).
   • Your state may offer an online registry. This is a place you can store your advance directive online so authorized healthcare providers can find it right away.
   • Read the forms carefully. Some states may restrict the types of decisions that a health care agent can make or may limit the health care agent's authority to only those decisions written in your living will.
   • Depending on the laws in your state, you may wish to involve your health care agent as you write your living will so that your agent fully understands your wishes.
4. Tell your family, your doctors, and anyone else who might be involved in your medical care who your agent is and how to contact your agent.
   • Keep copies of your living will and health care agent documents in a safe but easy-to-access place where others can find them.
   • Give copies of these documents to your doctor, your agent, your family members, and anyone else who may need them.

Where to Go From Here

Talk with your family about whom you have selected as your health care agent and explain the reasons why. Try to openly discuss the types of medical care you would or would not want under various circumstances. Make it an ongoing conversation. You may decide to first introduce the idea by bringing up the fact that you have selected an agent. If your family has difficulty discussing the issue, provide more information gradually.

Make sure your advance directive forms are kept in a safe but accessible place, such as in your desk with other important papers. Let your loved ones know where you keep your forms. Give copies to:

• The person that you choose for your agent and any alternate agents.
• Your lawyer.
• Your doctor or doctors.
• Family members.
• Any other person who may be called if you have a medical emergency.

Do not keep your advance directive forms in a safe deposit box. If you are not able to communicate, your family may not know how to access these forms. Also, don't rely on your lawyer to be able to provide the documents when they are needed. Your family may not know whom to contact.

You can make changes to any advance directive at any time. This includes changing your health care agent. You should fill out a new form for any changes except very minor ones, such as a new phone number or address.

Communicate with your health care agent. If you change your mind about medical care matters and make a new living will, keep your health care agent up to date.

For more information on living wills and medical powers of attorney, see the topic Writing an Advance Directive. For more information on other end-of-life issues, see the topics Hospice Care and Care at the End of Life.