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What is a healthcare proxy, and how do I pick one that is right for me?
In the medical setting, a healthcare proxy (HCP) is an agent that a patient can appoint to make healthcare decisions on their behalf.
HCPs gain the power to make decisions on the patient’s behalf to conduct tests, procedures, and treatments only when the patient is unable to make or deliver their own healthcare needs appropriately. (Examples range from patients who suffer severe injuries, to those who enter a persistent vegetative state, to those with certain psychiatric conditions.) HCPs have this responsibility only as long as the patient does not possess these abilities.
Often, an HCP is a family member or a close friend, but this role can be granted to anyone in the patient’s life. Up until age 18, parents automatically serve as their children’s HCP.
The process of appointing an HCP can seem daunting. However, HCPs are a crucial part of advanced care planning (ACP), and can greatly improve outcomes—as well as avoid unwanted medical care—if certain situations arise.
In addition, the downsides of failing to select an HCP can be quite severe. Families of patients often have dissenting views on healthcare management. This can increase stress, delay treatments, and worsen prognosis.
Things to consider when selecting an HCP
When should you consider finding an HCP?
While an HCP only makes decisions on a patient’s behalf in certain scenarios, the sad reality is that anyone, regardless of age or health status, can suddenly find themselves in a situation where they are unable to speak for themselves. Choosing your HCP early and building a relationship with them prior to any incident can prove beneficial in the event that stressful circumstances arise.
How well do you and your HCP know each other?
Because an HCP is a surrogate, meaning they will be making decisions on your behalf, it is essential that they understand and respect you and your healthcare choices. Establishing trust, speaking openly, and revisiting your wishes with your HCP should be viewed as a routine part of your own healthcare maintenance. The better your HCP knows your values, goals, and fears regarding treatments—including procedures and life-sustaining interventions—the more effective they will be in carrying out your medical wishes if those situations arise.
Do you trust your HCP to carry out your medical preferences?
Trust is a crucial component in any relationship, and this principle applies especially with an HCP. It can be a great mental strain to grant someone decision-making capacity over your life. It is important to be direct and transparent and ensure that the person fully understands and accepts the demands of the role.
While it is the HCP’s responsibility to act in keeping with your values, everyone is entitled to their own set of beliefs. Making sure your HCP can respect and execute your medical wishes, even if there is dissent, is key. It is also important that they are assertive on your behalf and accessible, both in terms of geography and ability to communicate.
Have you filed your paperwork?
Each state has unique guidelines regarding what documents are needed to appoint an HCP as well as what responsibilities fall to the HCP. Often, what is needed is an Advance Directive form, which is available online and in most healthcare settings. Having multiple signed copies of this form available to you, your HCP, and your primary care provider can better prepare you in these types of situations.
What does your plan depend on?
While appointing an HCP is a crucial step, it is only one part of your advance care planning. In the event that your HCP is unable to perform, or if you have no one in your life whom you can trust with these responsibilities, you should look to other tools, including living wills, to make your medical wishes clear. In addition, certain states, such as Massachusetts, encourage the use of assigning alternate HCPs as backups to the primary one.
In closing, a good HCP is someone who is reliable and nonjudgmental. They listen to and respect your beliefs, are systematic in their decision making, can speak to an array of audiences—ranging from healthcare providers to younger family members—and possess mental toughness in standing up for your values and making tough decisions. It is never too late to begin this process, strengthen this relationship if it already exists, or revisit these discussions if they have already begun.