Health care proxy
|This article's factual accuracy is disputed. (August 2010)|
A health care proxy is an instrument (or document) that allows a patient to appoint an agent to make health care decisions in the event that the primary individual is incapable of executing such decisions. Once the document is drafted, the primary individual continues to be allowed to make health care decisions as long as they are still competent to do so. Depending on the legal jurisdiction, health care proxies may or may not be mandatory. Regardless, they allow a patient's wishes to be followed even when he/she is incapable of communicating them. In many jurisdictions, a health care proxy is closely related to a "springing" health care power of attorney; with many practitioners using these two terms interchangeably.
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 health care 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 health care. 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 health care proxy form, the agent can make most other decisions in accordance with what the primary individual would have wanted. 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 health care proxy form in USA
Health care proxies are permitted in forty-nine states as well as the District of Columbia. Health care 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).
Contemporary importance of health care proxies
Health care proxies have become increasingly important today due to conflicts among relatives of the primary individual. The Terri Schiavo case is a famous modern-day example. Doctors tried to treat Schiavo for more than ten years and concluded that she was in a persistent vegetative state. Her husband, who stood to benefit financially from not having to divorce Schiavo and who wanted to re-marry, elected to have her feeding tube removed, but her parents objected. This resulted in a lengthy court battle that raised many political, moral, and medical issues. The whole controversy might have been avoided if Schiavo had assigned either her parents or her husband as her health care proxy. As a result, some commentators have argued that health care proxies should be made mandatory.
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.
- Power of attorney
- Advance health care directive
- Living will
- Uniform Rights of the Terminally Ill Act
- Do Not Resuscitate
- Patient refusal of nutrition and hydration
- Estate planning
- Ulysses pact
- "Medical Glossary". University of Miami School of Medicine.
- Rai, Arti (September 1999). "The Physician as a Healthcare Proxy". The Hastings Center Report. Hastings Center. Retrieved 2007-10-14.
- Health Care Powers of Attorney (interactive map), LawServer
- "Health Care Proxy - Appointing Your Health Care Agent in New York State". New York State Department of Health. June 2007. Retrieved 2007-10-14.
- The Ultimate Prescription: Make Us Decide How We Want To Die
- Kates, Tasha. After Terri Schiavo, Tampa Bay Online, july 5, 2009