This is the second article in a series that focuses on advance care planning — the process of discussing and documenting your wishes for medical treatment or care in the event your doctor is unable to determine what your medical wishes may be.
The first article of this series, available at www.dgaplans.org/what-is-advance-care-planning/, discussed the first two steps of the planning process:
- Understand your current health status
- Reflect and prioritize your care goals
This article will focus on step three: designating a health care agent.
Who Is a Health Care Agent?
In the event you are unable to communicate your wishes for medical treatment to medical staff, a health care agent is someone you’ve chosen to make medical decisions on your behalf or to advocate for the medical decisions you’ve already made and have communicated to them. They may also be referred to as a health care proxy, surrogate or representative.
Depending on the state in which you live, there may be limitations on who can serve as an agent. For example, in most states, a health care agent must be 18 years or older. In states like California, there may be additional restrictions (e.g., you may not select your treating health care provider or their employees to be your health care agent). To view your state’s specific restrictions, visit health.harvard.edu/state-limits.
Because this person is positioned to make life and death decisions, it is essential to understand your state’s requirements for health care agents and to choose someone you trust instead of leaving it to the mercy of state laws. If you don’t choose an agent or have a living will and become incapacitated, state laws may determine an authorized decision maker, and your spouse, child, friend or even attending doctor may be left to make decisions using their personal preferences instead of your wishes.
Things to Consider When Choosing Your Agent
When deciding who you will designate as your health care agent, it’s important to take time to think about your decision. Many states only allow you to select one agent at a time, so although spouses and children are common selections, there may be other people you wish to assume this role, like a friend, religious leader or lawyer.
To decide whom you should choose, consider your answers to these important questions:
- Do you trust this person to make life-altering decisions?
- Is this someone to whom you can communicate your medical wishes?
- Will this person be able to understand your wishes and be willing (logistically, emotionally, ethically, etc.) to advocate for them on your behalf?
- Is this person geographically close enough to come to a hospital quickly for you or able to make these decisions by phone?
- Will this person be willing and able to manage potential conflicts with loved ones?
Will You Be My Health Care Agent?
Once you have someone in mind, it’s best to take time to prepare for a conversation with them in which you ask them if they are willing to be your health care agent.
To prepare, write down your medical wishes and any religious beliefs, health conditions or values that influence the medical decisions you’ve made. Additionally, be prepared to explain why it is important to you that they be your health care agent and that, if they agree, you will formally add them to your advance care plan.
For tools to begin this conversation, see #1 in Three Misconceptions About End-of-Life Planning below.
Three Misconceptions About End-of-Life Planning
- Many assume a conversation about end-of-life planning with a loved one will be sad or awkward, but it doesn’t have to be. Look for end-of-life planning games like Hello or Go Wish (a card game where players sort their wishes) and similar tools to start the conversation.
- A dying loved one refusing to drink or eat may be interpreted as them choosing to starve to death, but this is a normal part of the physical process of dying. As a health care agent, it’s important to consult their physician to gain an understanding of whether food or fluids may help prolong a terminally ill person’s life or decrease their suffering.
- Although many people would prefer to die at home, most people die in a medical facility (e.g., hospital, hospice center, etc.) where medical professionals provide end-of-life care. This makes it even more important to document your wishes and to share them with a trusted advocate.
Conclusion
A conversation about your wishes and an agreement to execute them are essential steps before formally documenting a person as your health care agent in your advance care plan.
After this conversation, it’s recommended you prepare advance directives and document your wishes in a living will as a part of your advance care plan. The next article in this series will focus on advance directives, the documents that make up your care plan, and the last step of the advance care planning process: communicating your wishes to your health care agent and medical providers.
