Choosing Your Healthcare Agent

A healthcare agent is someone you designate to make medical decisions on your behalf if, at some future time, you are unable to make decision’s for yourself. Your agent can be a close relative or a personal friend, but should be someone who knows you well and whom you trust completely. Your healthcare agent should be a person who knows your wishes about medical treatment, and who is willing to take responsibility to ensure those wishes are followed. In most states, your agent can make decisions any time you lose the ability to make a medical decision, not just decisions about the end of life.

Ideally, your agent should be someone who is not afraid to ask questions of healthcare professionals in order to get information needed to make decisions. Your agent may need to be assertive to ensure that your wishes are respected. Your agent will need to know as much as possible about your wishes and values regarding the use of medical technology. Not everyone is comfortable accepting this sort of responsibility; therefore, it is very important to have an honest discussion with the person you plan to appoint before you make the appointment.

Talk with your healthcare agent about your end-of-life wishes.

Your healthcare agent needs to know about the quality of life that is important to you and when and what medical treatments you would want. Talking to your agent means discussing values and quality-of-life issues as well as treatments and medical situations. Because situations could occur that you might not anticipate, your agent may need to base a decision on what s/he knows about your values and your views of what makes a good quality of life. These are not simple questions, and your views may change. For this reason, you need to talk to your agent in depth and over time.

The following questions may help you discuss these issues with your healthcare agent:

• Are there treatments you particularly want to receive or refuse?
• What are you afraid might happen if you can't make decisions for yourself?
• Do you have any particular fears or concerns about the medical treatments that you might receive? Under what circumstances?

The following questions may also help you to clarify your wishes to your healthcare agent:

• What are your views about artificial nutrition (food) and hydration (fluid)?
• If your heart stopped, under what circumstances would you want doctors to use CPR to try to resuscitate you?
• Would you want to receive treatments such as mechanical ventilation, antibiotics, or tube feeding for a time, but have them stopped if there were no improvement in your condition?
• Do you want to receive these types of treatment no matter what your medical condition? On a trial basis? Never?

Benefits of Having an Agent

• The agent knows you and understands your wishes about medical treatments. S/he can make decisions in situations you might not have anticipated.
• An agent has flexibility. S/he can talk with your physicians about your changing medical condition and authorize treatment or have it withdrawn as circumstances change.
• If you have prepared a living will, your agent can interpret it in situations that were not foreseen. Be sure to make clear in your living will that your agent should make decisions on how to interpret it or when to apply it.
• Your agent can advocate for you. If healthcare providers resist following your wishes, your agent can negotiate with them and take any other necessary steps to see that your wishes are honored.

Selecting an Agent

• Select someone whom you trust and who understands your decisions.
• Because you are asking your agent to accept significant responsibility, be certain to ask your agent if s/he is willing to act on your behalf. Not everyone is able to be an effective agent.
• Talk to your agent about your wishes regarding end-of-life medical treatment. Even family members may not know how much treatment a loved one would be willing to accept near the end of life. Talking clarifies what you want and diminishes an agent's potential guilt and anguish over whether s/he is doing the right thing.
• Prepare and sign the appropriate advance directive forms for your state. Keep the original and give copies to your agent and alternate agents, family and doctors and have it placed in your medical record.

Information provided by Coalition for Compassionate Care of California (CCCC).