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Healthcare Proxy: How To Choose The Right Person

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Appoint a Healthcare Proxy and at least one alternate with a good deal of thought. (An alternate is recommended in case something happens to your first choice, or he or she is not available or chooses not to serve when the time comes.) Most people appoint a spouse or adult child without considering whether he or she is suitable for the job. For instance, Rose appointed her husband John to be her Proxy on the understanding that he would turn off a ventilator if there was no reasonable chance for her to recover. When Rose ended up in that situation, John insisted that she put on a ventilator.Contrary to her wishes, he even fought to keep it on. He said he had depended on her all his adult life and he couldn't imagine living without her. 

Because of the potential for conflict and confusion, it is better not to appoint more than one person in each position.

Factors To Consider When Deciding Who To Appoint As Healthcare Proxy

When deciding who to ask to be your Healthcare Proxy, consider:

  • The person's age. 
    • You do not want someone who cannot make a legally binding decision (say under age 18).
    • At the other extreme, a person of advanced age may not be here to make the necessary decisions.
  • The person's mental and emotional ability. Preferably, a Proxy should be someone who:
    • Can understand what is happening and the alternatives.
    • Can apply your wishes to the situation.
    • Can make objective decisions in emergency situations, especially those involving emotional decisions. For instance, an in-law may be a good Proxy because he or she is one step removed from the emotional overlay of the situation.
    • Knows you and your wishes.
  • How comfortable you are discussing these issues with the person.
  • Whether the person respects your right to receive the level of treatment that you want, even if your wishes differ from the person's own wishes in a similar situation. 
  • Whether the person has strong religious or other beliefs that would make it difficult to make a decision that is based on your wishes.
  • Whether the person has a financial interest in:
    • Your continuing survival 
    • Your early death.
  • Whether the person is strong and assertive enough to enforce your wishes should there be a conflict:
    • Without being intimidated by medical professionals. (Can he or she shout at a doctor if necessary?)
    • Possibly even against the opinions of other family members.
    • To get an idea of what the person may have to do to enforce your wishes, click here.
  • Whether the person is a sentimentalist. A sentimentalist may decide at the last moment to try to keep you alive against your wishes.
  • Whether the person will be available and accessible to you and your medical providers, preferably in person or at least by phone.
  • As a practical matter, if you also execute an Advance Directive for Mental health, it is better to name the same person as agent or proxy in both documentsing Will so there is no conflict. It doesn't matter whether a person you give authority to concerning your financial matters is the same - these are two different issues.
  • If you have a partner to whom you are not marriedAs a general matter, that person is not legally your spouse or even a relative. He or she may be barred from even visiting you if you are in a medical facility. If you appoint that person your Health Care Proxy, he or she would have the legal right to visit. 
  • Spouses: Divorce Or Legal Separation: In some states, if you appoint a spouse as a Proxy, the spouse's right is automatically terminated in the event of a divorce or legal separation, unless you provide to the contrary in the Healthcare Power of Attorney.

Do not appoint as your Healthcare Proxy:

  • A person just because he or she is the expected person.  As noted in the beginning of this article, a spouse may have a conflict of interest and not do what you want if the time comes. 
  • More than one person to serve as Proxy at the same time unless you have a very good reason.
    • If there is a conflict, there can be a long delay in making a decision, causing unnecessary suffering and expense.
    • Do not interpret this to mean that  you should not appoint someone to take over if the person you name as Proxy is not available or decides not to act as Proxy. In fact, it is good to have a substitute in place "just in case."  If you appoint a substitute, be clear that the person has no say in decisions as long as the first person acts as Proxy.
  • Your doctor or another one of your professional caregivers. In fact, many states prohibit healthcare workers from serving as Healthcare Proxies even to their own family members. There is too great a potential for a conflict of interest because it is in a professional caregiver's economic interest to keep treating you.
  • A person who stands to inherit a good deal of money if you want to be kept alive as long as possible through whatever means necessary if there is any question whether the person's actions will be influenced by the money.
  • Someone who has a psychological or emotional reason for keeping you alive if that is not what you want.
  • Someone who has mixed feelings about you.
  • A minor.
  • A person who is not mentally competent. 

It is generally preferable not to appoint a divorced spouse or one from whom you are separated because there may be a conflict of interest.

If You Cannot Think Of Anyone That You Believe Would Effectively Carry Out Your Wishes If You Become Unable To:  

  • Consider appointing a professional healthcare surrogate who has the same religious and end-of-life beliefs you do - or who will at least honor your religious beliefs.
  • It may be better not to appoint a Healthcare Power Proxy at all. In that case, the importance of the other Advance Directives (a Living Will , Do Not Resuscitate Directive), POLST in states where available) is even greater. Make sure your Living Will is as specific as possible about your wishes.

NOTE: Be sure to discuss your wishes with your Proxy. For helpful tips, see: What Should I Discuss With My Proxy?


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