The Importance of a Healthcare Proxy & Medical Directive

Imagine being in a situation where you can’t communicate with doctors, family, or caregivers. How would they know what care you want? Would your loved ones be left to make decisions on your behalf, possibly without knowing what you would have wanted? Planning for the unexpected is never easy, especially when it comes to your health. But when it comes to medical decisions, having your wishes clearly documented can provide peace of mind for you and your loved ones.

Planning your medical directives allows you to clearly outline your healthcare preferences for situations such as:

• What kind of life-sustaining treatments you do or don’t want (e.g., CPR, mechanical ventilation, feeding tubes).

• Whether you would like to be resuscitated or not in the case of a medical emergency.

• Your preferences for end-of-life care, such as hospice or palliative care.

• Who should make decisions for you if you're unable to do so.

Key Documents to Set in Place

Important documents to consider when planning your medical wishes are:

1. Advance Healthcare Directive (Living Will)
   This document outlines your preferences for medical treatment in case you're unable to communicate them yourself. It can cover a variety of decisions, from whether you want life support to how you want to be treated if you are terminally ill. This document acts as your voice when you're not in a position to speak for yourself.

2. Durable Power of Attorney for Healthcare (Healthcare POA)
   This document designates someone you trust to make medical decisions on your behalf if you're incapacitated. It’s different from a living will because it allows your designated agent to make decisions based on your general values and best interests, even if those decisions weren't specifically outlined.

Who Makes Medical Decisions If You Can’t?

Now, let's break down the roles of various individuals who could be responsible for making medical decisions on your behalf, and provide examples of where their power begins and ends.

1. Power of Attorney for Healthcare (Healthcare POA or Healthcare Proxy)

A Power of Attorney is someone you appoint to handle specific tasks or decisions for you, such as financial or legal matters. When it comes to healthcare, a Healthcare Power of Attorney (or Healthcare Proxy) is the individual you designate to make medical decisions for you if you cannot communicate them yourself. This person is usually someone you trust deeply, like a spouse, close family member, or trusted friend.

• What They Can Do: The Healthcare POA has the authority to make medical decisions, follow the instructions in your healthcare directive, and act in your best interest if you're unable to do so. For example, if you are in a coma or incapacitated, the healthcare POA can decide whether or not to continue life support, approve surgery, or transition you to hospice care.

• What They Can’t Do: The POA cannot make financial decisions unless you have a separate financial POA. They also cannot make decisions if you are still able to communicate or if you have revoked their authority.

  Example: If you are in a vegetative state, your healthcare POA may decide to transition you to palliative care if that aligns with your wishes outlined in your living will, even if other family members may have different opinions.

2. Healthcare Proxy / Legal Guardian

A Healthcare Proxy is a person you designate to make medical decisions if you are unable to make them yourself. This is typically part of the Healthcare POA, but in some cases, it can be a separate legal appointment. A legal guardian may also be appointed by the court if you become incapacitated without a healthcare proxy in place.

• What They Can Do: A healthcare proxy or legal guardian can make medical decisions and provide informed consent on your behalf. They are expected to act according to your documented wishes (in the case of a healthcare directive) or based on what they believe you would want. They may decide on life-sustaining treatments, pain management, or end-of-life care.

• What They Can’t Do: A legal guardian cannot make decisions about your medical care if you have already legally appointed someone else as your healthcare POA or if you have a clear living will with instructions. They also cannot act in ways that conflict with your clearly documented wishes.

  Example: If you are diagnosed with a terminal illness and cannot communicate, your healthcare proxy may decide to transition you to hospice care. However, if you’ve specified in your living will that you do not want life support, they cannot override those instructions to keep you alive artificially.

3. Next of Kin

Your next of kin typically refers to the closest living family members, such as a spouse, child, or parent. In the absence of an appointed healthcare proxy, the next of kin may be responsible for making medical decisions on your behalf. However, they may not have clear authority unless there's a legal document in place, like a healthcare POA or living will.

• What They Can Do: If no healthcare POA has been designated and no living will exists, your next of kin may step in to make decisions. This could include determining whether or not to pursue life-sustaining treatments or making decisions about organ donation if no prior documentation exists.

• What They Can’t Do: If you’ve designated someone as your healthcare POA or registered as an organ donor, the next of kin typically does not have the legal right to override these decisions unless there are strong reasons or specific state laws that allow them to.

  Example: If you’ve signed up as an organ donor but your family disagrees, they may have the ability to block organ donation in some areas, even if you registered as a donor. However, in some states, your documented wishes as an organ donor are legally binding.

We hope these examples have helped illustrate just how essential it is to have a medical directive in place and to appoint someone you trust deeply as your healthcare POA or healthcare proxy, to ensure your wishes are honored.

How to Ensure Your Wishes Are Honored

1. Have Open Conversations: Talk to the person you’re appointing as your Healthcare POA about your wishes. This ensures they understand what you want and are ready to make decisions based on your values.

2. Create Clear Documents: Make sure you have clear and legally valid documents in place, such as your Advance Healthcare Directive and Healthcare POA. Keep copies accessible for family, medical providers, and your healthcare proxy.

3. Review Regularly: Life circumstances change, and so might your healthcare preferences. It’s important to review your medical directives regularly to make sure they still reflect your wishes.

Disclaimer: We’re not legal or medical professionals, and the content here is based on our own experiences, research, and the expert advice we've received. Our goal is to offer helpful guidance to get you started on your end-of-life planning journey. We’re here to make those conversations a bit easier, and while we aim to provide reliable information, this blog is not intended to serve as legal or medical advice. We always recommend consulting with a qualified legal and medical professional to finalize your plans.