Healthcare proxy

A healthcare proxy is a document (legal instrument) with which a patient (primary individual) appoints an agent to legally make healthcare decisions on behalf of the patient, when he or she is incapable of making and executing the healthcare decisions stipulated in the proxy. Once the health care proxy is effective, the primary individual continues making healthcare decisions as long as he or she is legally competent to decide. Moreover, in legal-administrative functions, the healthcare proxy is a legal instrument akin to a "springing" health care power of attorney.

Criteria for being an agent

Some jurisdictions place limitations on the persons who can act as agents. (Some forbid the appointment of treating physicians as the healthcare proxy.) In any event the agent should be someone close to and trusted by the primary individual.

Powers and limitations of an agent

The agent is empowered when a qualified physician determines that the primary individual is unable to make decisions regarding healthcare. The agent has the power to remove or sustain feeding tubes from the primary individual if these tubes are the only things that are keeping the primary individual alive. The agent's decision stems from knowledge of the patient's desire in this matter. If the primary individual made his or her wishes clear on the proxy form, then they must be followed despite any possible objections from the agent. Beyond this matter, if there are no limitations on the healthcare proxy form, the agent can make most other decisions in accordance with what the primary individual would have wanted. However, an individual may have identified their end-of-life decisions in a living will or advanced health care directive that may supersede the agent's authority granted in the healthcare proxy depending on the language of the interrelated documents and state law. An agent will not be legally or financially liable for decisions made on behalf of the primary individual as long as they take into account the primary individual's wishes and beliefs.

Structure of typical healthcare proxy form in USA

Healthcare proxies are permitted in forty-nine states as well as the District of Columbia. Healthcare forms may differ in structure from state to state and pre-made forms are not compulsory as long as certain guidelines are met. The common guidelines include:

• Name and address of the agent.
• Name and address of an alternate agent.
• Duration of the proxy – not indicating a duration means it's valid unless stated otherwise.
• Special instructions – these can broaden or limit the powers of the agent. If the patient doesn't want to be on feeding tubes no matter what, this can be stated here. If there are certain treatments that the patient doesn't want to receive like dialysis or blood transfusion, then they must be indicated. However, if the patient wants to give the agent more flexibility with some or no restriction, this must be written.
• Name, date and signature of the primary individual.
• Instructions on tissue or organ donation.
• Two adult witnesses must sign the document stating that they have witnessed this agreement and that both parties appear to be sane. The witnesses must be 18 years or older. The agent and primary individual do not qualify as witnesses.
• Presence of a lawyer - such a person may help in drafting a document tailored to the needs of the primary individual.
• Once signed, copies of the form must be given to health care providers, the agent, spouse, and close friends. A copy should also be carried by the primary individual (in wallet or purse).

UK legal situation

In England and Wales, an independent mental health capacity advocate may be appointed under the Mental Capacity Act 2005; the provisions made in the same Act for a lasting power of attorney may also provide a satisfactory basis for providing care via an attorney, who does not require to be professionally qualified. Different arrangements apply elsewhere in the UK.

See also

• Advance healthcare directive
• Do Not Resuscitate (DNR)
• Estate planning
• Living will
• Patient refusal of nutrition and hydration
• Power of attorney
• Ulysses pact
• Uniform Rights of the Terminally Ill Act