How to Select Your Health Care Agent or Proxy

How to Select
Your Health Care Agent or Proxy
Name & Date_______________________________________
When you decide to pick someone to speak for you in a medical crisis, in case you are not able to speak for yourself, there are several things to think about. This tool will help you decide who the best person is. Usually it is best to name one person or agent to serve at a time, with at least one successor, or back-up person, in case the first person is not available when needed.
Compare up to 3 people with this tool. The persons best suited to be your Health Care Agents or Proxies rate well on these qualifications...
Name #1:
Name #2:
Name #3:

1. Meets the legal criteria in your state for acting as agent or proxy or representative? (This is a must! See next page.)
   
2. Would be willing to speak on your behalf.
   
3. Would be able to act on your wishes and separate his/her own feelings from yours.
   
4. Lives close by or could travel to be at your side if needed.
   
5. Knows you well and understands what’s important to you.
   
6. Is someone you trust with your life.
   
7. Will talk with you now about sensitive issues and will listen to your wishes.
   
8. Will likely be available long into the future.
   
9. Would be able to handle conflicting opinions between family members, friends, and medical personnel.
   
10. Can be a strong advocate in the face of an unresponsive doctor or institution.
    

 

ABA Commission on Law and Aging Tool 1 / Page 1

The person you choose to make health care decisions for you is known by different names in different states. This person is sometimes called a health care agent, proxy, representative, attorney-in-fact, surrogate, or even patient advocate.
Who Can’t Be a Proxy?
State rules for who may be a health care proxy vary, but the most common groups disqualified
are these:

• !  Anyone under age 18.
  
• !  Your health care provider, including the owner or operator of a health or residential or community care facility serving you—unless this person is your spouse or close relative.
  
• !  An employee of your health care provider—unless this person is your spouse or close relative.
  WHAT TO DO AFTER YOU PICK A HEALTH CARE PROXY?
  
  • !  Talk to your proxy about the qualifications on the first page of this worksheet.
    
  • !  Ask permission to name him or her as your proxy.
    
  • !  Discuss your health care wishes and values and fears with your proxy.
    
  • !  Make sure your proxy gets a copy of your advance directive and a copy of the worksheets you used in this kit, and knows where to find the originals.
    
  • !  Give your proxy a copy of Tool # 9: Guide for Health Care Proxies.
    
  • !  Tell family members and close friends whom you picked.
    HOW MUCH AUTHORITY SHOULD YOU GIVE YOUR AGENT?
    Most people wish to give their agent the broadest authority possible to make all health care decisions when they are no longer able, including those about the use of life-sustaining treatments such as artificial nutrition and hydration. If you do not wish to give such broad authority to the proxy you have selected, think about what limitations you would impose and describe them here as best you can:
    Key Question: If you include written instructions in your advance medical directive and there is a conflict between your proxy’s instruction and your advance directive, which takes priority?
    My agent’s direction My advance medical directive
    

ABA Commission on Law and Aging Tool 1 / Page 2
source http://www.americanbar.org/content/dam/aba/migrated/aging/toolkit/tool1.authcheckdam.pdf