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Healthcare Proxies and Advance Healthcare Directives

What if a serious accident, injury or illness affected your ability to make decisions? Have you thought about what care you’d want? Healthcare proxies and advance healthcare directives can help you plan your care if you ever lose the ability to communicate clearly. This article will tell you about your options for planning your healthcare decisions ahead of time.

This article doesn’t provide medical or legal advice. Consider speaking to a lawyer for questions about your specific legal situation, and a doctor if you need help to guide your healthcare decision making.

What Are Healthcare Proxies and Advance Healthcare Directives?
Healthcare proxies are a type of advance healthcare directive. Advance healthcare directives are legal documents that help to tell doctors what kind of care you want if you can’t tell them yourself. Another type of advance healthcare directive is a living will.

Healthcare proxies. The term healthcare proxy can refer to the document you create to pick a person to make healthcare decisions for you. It can also mean that person. Another name for the document is a durable power of attorney for healthcare. Another name for the person is a healthcare surrogate. The person might also be called a healthcare agent or representative. The person you pick to be your healthcare proxy can make decisions about your medications and other treatments when you can’t make those decisions yourself. This could happen toward the end of your life. It could also be during a temporary illness or injury.

Living wills. A living will is a document that tells doctors about the care you would like to get if you can’t make your own decisions about treatment. Living wills are used when you have a very serious illness or injury that is life-threatening. You can let doctors know which kinds of treatments you prefer and which kinds you want to avoid. Sometimes living wills are called personal directives or healthcare instructions.

Deciding Whether to Create an Advance Healthcare Directive
Your rights. State laws in all 50 states give you the right to make your own healthcare decisions in advance. For example:

• You can create an advance healthcare directive even if you’re a young and healthy adult.
• If you have children under 18, you’re automatically their healthcare proxy.
• The advance healthcare directive takes effect only when a doctor decides you can no longer make your healthcare decisions.

Advantages. An advance directive allows you to tell healthcare providers your choices. It can avoid unnecessary or unwanted pain, procedures and hospitalizations. It can also bring peace of mind, knowing your wishes will be carried out.

Disadvantages. An advance directive won’t cover every possible situation and can’t guarantee specific treatments or results. There might be a situation that you didn’t discuss with your proxy. There might also be a situation where your proxy or healthcare team don’t follow your wishes.

What Happens If I Don’t Have an Advance Healthcare Directive?
If you get injured or become ill without an advance directive, the state laws where you live will decide who can make healthcare decisions for you. Most often it will be your spouse if you’re married. It could also be your parents or your adult children. If you have no family, it could be a close friend or a doctor that the state assigns. Contact your state bar association or legal aid office to find out more.

How Do I Get Started?
Choose a healthcare proxy. This could be your spouse, your parent, your friend, your faith leader or anyone you trust. Different states have different rules on who can’t be a healthcare proxy. For example, you may not be able to pick someone who’s financially responsible for your healthcare. Check your state rules to be sure. Once you’ve picked someone, ask that person if he or she is willing to be your proxy.

Share your preferences. Tell your proxy how you hope to be treated and any procedures or treatments you don’t want. Let your proxy know what matters most to you so your proxy can make the best decision possible. You can use this Conversation Starter Guide to help.

Write it down and share it. You don’t need to use a special form but if you prefer, you can fill out a healthcare proxy form. You can often get state-specific forms for free that can include living wills. Find some here. Make sure to share the information with your healthcare providers and your close family and friends.

If you choose to create a living will, using a workbook like this one can help you decide what matters to you. For example, you might want to include instructions that say do not resuscitate (DNR), do not intubate (DNI) or do not hospitalize (DNH). These might be part of your state’s living will form. However, you can also ask your doctor about adding these to your record as medical orders.

Revisit often. It’s a good idea to refer back to your advance directive regularly, especially if a major life event happens. Such life events can include getting married, moving, or getting diagnosed with an illness. That way you can be sure your wishes are up to date. You can always change your proxy or update your living will at any time.

Do I Need a Lawyer and Is an Advance Directive Legally Binding?
You don’t necessarily need a lawyer to set up a healthcare proxy or living will. However, you may want to talk with a lawyer, as laws are different depending on your state.

Advance healthcare directives are legal documents, but they’re not legally binding. Your healthcare team must try to follow your wishes as laid out in your living will or dictated by your proxy. But if your doctors disagree with your wishes, they don’t have to follow them. Instead, they must arrange for you to be treated by a doctor or hospital that will.

What If You’re a Healthcare Proxy?
It can feel overwhelming to have to make decisions for another person. Check out some resources on How To Make Medical Decisions for Other People. Also, if you’re a caregiver, check out our article on getting help for caregivers here.

Resources
PREPARE for your care has resources for preparing for your own care and preparing for care of other people.

The Conversation Project is an initiative to help people talk about their wishes for care through the end of life.

National Institute on Aging: Advance Care Planning has information to help you plan ahead for future health problems and end-of-life care.