What qualities should I look for in a healthcare proxy?

Barbara Coombs Lee
Hospice Nursing Specialist

States use various names for the person designated to make health care decisions if we are unable to make them for ourselves. Some of the terms are “attorney-in-fact for healthcare”, “healthcare agent”, “proxy”, or “surrogate.” They all mean the same thing, and you are wise to think carefully about who would be well-suited for this task. Here are some considerations:

  1. Does the person know me well enough to understand my values and beliefs?
  2. Can they articulate accurately how I personally balance the quality of my life with its absolute quantity?
  3. Is the person able to adapt their understanding to unforeseen circumstances?
  4. Could they take the principles I live by and apply them to a situation I may never have spoken of specifically?
  5. This is a quality of abstract thinking. Can the person understand a broad principle and apply it to a specific set of facts?
  6. Do they care for me enough to be passionate about honoring my wishes? Might grief cloud their judgment?
  7. Can this person be strong in the face of medical authority and attempts to influence their decision? Often doctors have very specific ideas about appropriate treatment. Their influence can be subtle: “I doubt your loved one meant to refuse a feeding tube as a life-sustaining treatment.” And it can be downright coercive: “If that is your decision, we will be forced to notify the authorities at the state protection agency.” Calm thinking and resolute decision-making are important qualities in a surrogate decision-maker.
  8. Does this person have the respect and affection of others close to me? If you have a large family, someone might question or doubt whether a decision is correct. The person you choose will have an easier time if others know them as a loving, compassionate and intelligent thinker.

Other considerations:
If you name no one, almost every state law includes a prioritized list of relatives who will be deemed the decision-maker, if they are willing and able. The list usually begins with the spouse, then parent, then a consensus of adult children, and so on, to more remote relatives and even a friend or acquaintance. If someone close to the top of this list would be especially inappropriate in your case, it is doubly important to name a person formally, so the inappropriate relative does not gain authority by default.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

The person you designate to call the shots for you in a medical emergency or when you can't speak for yourself—either for a finite one-time treatment period or in perpetuity, might be called your agent, attorney-in-fact, proxy, or surrogate. The person you deputize as your decision maker may be the same person as your health care advocate (your partner in all things medical). Or it can be your spouse.

Obviously, being a proxy is one heck of a responsibility. This person must be up to the task—mentally, physically, and emotionally. And your proxy needs to be comfortable with the role (well, as comfortable as possible), and confident she or he can do the job.

The three qualities you need your proxy to have, aside from those that prompted you to have absolute trust in this person in the first place, are:

  • Assertiveness. They need to be able to state your wishes and stay firm to them amid differing opinions from relatives and hospital staffs, though still be open-minded and discerning enough to know if some bit of exceptional new information warrants a possible change in plans.
  • Accessibility. If they live in Moscow (and you don't), or it takes nine phone calls and four reschedules from personal assistants to see them, they're not going to make a good proxy. You need someone who can be available quickly and give you their attention for undetermined periods.
  • Money sense. There's a good chance that the person you pick to be your health care proxy will also be your financial proxy (having them be the same person can smoothen things considerably), so this person has to know how to handle a buck—and to be able to understand and follow your instructions on how your finances should be allocated for your care.
YOU: The Smart Patient: An Insider's Handbook for Getting the Best Treatment

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YOU: The Smart Patient: An Insider's Handbook for Getting the Best Treatment

Everyone needs to become a smart patient. In fact, in the worst cases, your life may even depend on it. Number one bestselling authors and doctors Michael Roizen and Mehmet Oz have written this indispensable handbook to help everyone to get the best health care possible -- by making everyone into their own medical detective.Witty, playful, at times offbeat, but always authoritative, You: The Smart Patient shows you how to become your own medical sleuth, tracing your medical family tree and wending your way through the pitfalls of any health care situation. Written in conjunction with the health care community's leading oversight group, The Joint Commission, the book shows readers in clear, easy steps how to take control of their own health care and deal with all matters that may come up when facing a medical case: from choosing the right doctor, hospital, and insurance company to navigating prescription drugs, specialists, treatment options, alternative medicine, pain management, or any problem that might arise.Accessible, humorous, and filled with information that you need, You: The Smart Patient is a book for every patient and all those dealing with a loved one's medical issues.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.