Tackling Tough Health Decisions With a Health Care Proxy
Some of the hardest choices you will ever make involve coming to terms with your own illnesses or incapacity. It is normal to shy away from dwelling on terminal scenarios. Besides, beliefs and desires often evolve over time. If you were very sick, would you prioritize your comfort over prolonging your life? Whom would you trust to act in your best interests? How long are you willing to try every conceivable treatment?
After you confront these stressful questions, discuss your preferences with someone who could step in if you were unable to make these types of decisions yourself. Having had those exacting conversations, you should prepare a set of documents, known as advance directives, that clearly spell out your preferences for medical treatments and end-of-life decisions.
These documents, comprising a health care proxy and a living will, are the core elements of your estate planning. They may have enormous consequences for you and your family. Think of them as a type of insurance in case you are unable to communicate your wishes yourself.
A health care proxy is the legal document that officially authorizes a trusted adult you appoint — your proxy — to make your medical decisions for you in the event doctors have determined that you have lost the ability to make them. Suppose you were in a car accident and you were unconscious or in a coma. Would you prefer artificial hydration and nutrition? How do you feel about organ donations? If you had no health care proxy, those decisions would be made according to state law.
It is advisable to prepare a directive for any state in which you spend much time. There is no harm in being prepared for even unlikely catastrophes, especially since you can always draw up a replacement form at any time, changing the terms or designated person.
The other key document is a living will, which is used for end-of-life situations. It might cover contingencies like mechanical ventilation, do-not-resuscitate orders or dialysis. Ideally, he health care proxy and the living will should be structured to work in tandem, but in the case of a conflict, the living will prevails. Living will instructions can be specific, but take care not to make the language impossibly narrow. Although family members cannot override a living will, doctors still have decision-making power if ethical obligations compel them to use it.
(Lastly, a power of attorney for financial decisions is a set of instructions different and distinct from the health documents. Don’t confuse them.)
Rights and duties
Who would be a suitable person to enlist as proxy? Some traits may stand out. You would probably seek someone who thoroughly knows and understands your values, and who is unruffled under pressure. They should be ready to advocate, be fearless about asking questions and perhaps also be a diplomatic communicator, as other family members are likely to become involved.
The proxy will be tasked with an array of responsibilities. Examples are:
- Reviewing medical charts.
- Discussing treatment options.
- Considering tests, procedures and treatments.
- Prioritizing hospital visits.
- Requesting second opinions.
But will your chosen proxy be willing? There are many valid reasons for them to hesitate or refuse. For instance, they may waver or have trouble making decisions. They may be located far away and have to travel to fulfill this obligation. Or they may harbor moral objections to procedures for religious or ethical reasons. Be sure to clarify these issues in advance!
A health care proxy can shield a family from painful choices that no one is eager to make. A living will can also prove indispensable. For instance, it may be necessary to obtain a court order to end life support. Nonetheless, ambiguities might fuel challenges to a proxy’s interpretations or lead to conflict between doctors and families.
With so many challenges and an unknowable future, it is particularly important to request your attorney’s help in completing the advance directive documents.