Being a Healthcare Proxy

A healthcare proxy is someone who represents a person who cannot speak for themselves. The name of this role varies by state. It may be called a Durable Medical Power of Attorney or a Durable Power of Attorney for Healthcare. It may also be called an agent, surrogate, or advocate or it may be called a representative or decision maker. It is an official duty that is noted by a legal document. The document also varies by state. The person must name you as his or her proxy on the document.

A healthcare proxy speaks for another person when he or she is not able to do so. The proxy helps make sure the person’s healthcare wishes are known and followed.

What it means to be a healthcare proxy

Your role as healthcare proxy starts when the person can’t make medical decisions. This is known as loss of capacity for medical decision-making. This assessment can only be made by a licensed healthcare provider. You, as proxy, then make the healthcare decisions as needed. You do this by carrying out the person’s wishes as noted in his or her advance care planning documents. These documents declare what kind of treatment the person wishes to have or not have. As a healthcare proxy, you must fully understand that it is your legal obligation to follow the patient's wishes stated in their advanced directive, and NOT make decisions against the patient’s wishes unless the intervention is not likely to improve the patient's function. You may need to put aside your own values and opinions to carry out the person’s wishes. This may include refusing or stopping life-sustaining treatments.

Documenting end-of-life wishes

As a healthcare proxy, encourage the person to discuss his or her wishes, while they are able. They can do this with their healthcare provider and then document the wishes as a medical order. The provider can help the person complete the form. The forms are known by different names depending on the state. The form may be called one of these:

• MOLST (medical orders for life-sustaining treatment)
• POLST (physician orders for life-sustaining treatment)
• MOST (medical orders for scope of treatment)
• POST (physician orders for scope of treatment)
• TPOPP (transportable physician orders for patient preferences)

The form documents the person’s wishes at the end of life. It's not tied to a certain healthcare provider or facility. It's different than a living will. The form is an order written according to state regulations by a healthcare provider. To complete one, the person must express his or her wishes to an advanced healthcare provider. If the person can’t make his or her own decisions, then this is done by the person’s healthcare proxy.

Carrying out your role

Your duties depend on what the person’s advance care planning documents say. Your duties may also depend on state law.

In general:

• Before accepting a role as a proxy, talk with the person. Be sure you know his or her wishes. Ask questions. This will help you be his or her voice if and when it is needed.
• Be sure that the person’s healthcare team knows that you are his or her proxy. Carry a copy of the document and proof of your identity.
• Make sure the healthcare team has a copy of the person’s advance care planning documents.
• Talk to the healthcare team. Ask questions as often as you need. Stay informed about the person’s condition.
• Ask for any help you need to understand the medical situation. Ask about the person’s condition and prognosis. Ask about risks and benefits of tests and treatments. Find out all the facts and options.
• Speak on the person’s behalf with the healthcare team when needed.
• Talk with family members and keep them informed.
• Know your rights. You have the right to ask for information. You can ask for consultations and second opinions. You have the right to request or refuse treatment for the person. You may be able to review his or her medical chart. You can authorize the person’s transfer to another facility. You can also request a new healthcare provider for him or her. If you are not sure what your rights are at any time, ask a legal advisor.

When it’s time to make decisions

If the person’s wishes are clear in the advance care plan documents, ask for them to be carried out as noted. If they are not clear, talk with the healthcare team. Listen to the team’s recommendations. Talk with a spiritual advisor or counselor. It may be hard for you to make a decision at times. You may feel sad or upset about a decision. Being a healthcare proxy is not an easy role. But it is an important one. Remember that the person trusts you to carry out his or her wishes.

© The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions. This information has been modified by your health care provider with permission from the publisher.