Being a Health Care Proxy
A health care proxy is a person who represents a patient when the patient can’t speak for himself or herself. The name of this role varies by state. It may be called a Durable Medical Power of Attorney or Durable Power of Attorney for Health Care. It may be called an agent, surrogate, or advocate. Or it may be called a representative or decision maker. It is an official duty that is identified by a legal document. The document also varies by state. The patient must name you as his or her proxy on the document.
What it means to be a health care proxy
Being a proxy means that you speak on behalf of the patient. Your role begins when the patient cannot make medical decisions. You then make the decisions as needed. You do this by carrying out the patient’s wishes as noted in his or her advance care planning documents. This is a series of legal documents. They also vary by state. They declare what kind of treatment the patient wishes to have or not have. Understand that you will speak for the patient only. You may need to put aside your own values and opinions to carry out the patient’s wishes. This may include refusing or stopping life-sustaining treatments.
Carrying out your role
Your duties depend on what the patient’s advance care planning documents says. They may also depend on state law. In general:
Before accepting a role as a proxy, talk with the patient. 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 patient’s health care team knows that you are his or her proxy. Carry a copy of the document and proof of your identification.
Make sure the health care team has a copy of the patient’s advance care planning documents.
Talk to the health care team and ask questions as often as you need. Stay informed about the patient’s condition.
Ask for any help you need to understand the medical situation. Ask about the patient’s condition and prognosis. Ask about risks and benefits of tests and treatments. Find out all the facts and options.
Speak on the patient’s behalf with the health care 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 patient. You may be able to review the patient’s medical chart. You can authorize a transfer of the patient to another facility. You can also request a new health care provider for the patient. 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 patient’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 health care 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 health care proxy is not an easy role. But it is an important one. Remember that the patient trusts you to carry out his or her wishes.
MOLST or POLST (medical or physician orders for life-sustaining treatment, depending on the state of residence)
A MOLST or POLST documents wishes at the end of life. It is not tied to a particular health care provider or facility. Different than a living will, a MOLST or POLST is an order written according to state regulations by an advanced health care professional. To complete a MOLST or POLST, the patient must express his or her wishes to an advanced health care professional. If the patient is unable to make his or her own decisions, then this is done by his or her health care proxy.
If you need help
Ask for help if you have trouble with a decision. The health care team will want to help you.
You may need help in resolving family conflicts. Ask the hospital social worker, ethics consultant, or a spiritual advisor for help.
If you are having trouble talking with the health care team, talk to the hospital ombudsman or ethics committee.