Following are the steps to take to help maximize chances that your wishes will be understood and followed by your Health Care Proxy. Once you have a person picked as your Proxy, it is recommended that you follow the same procedure with your Alternate Proxy. (Please click on the links to learn about each step)

Step 1. Think through what you do and do not want if there are medical decisions to be made and you cannot communicate your wishes.

Step 2. Discuss with the person whether he or she is willing to act as your Proxy.

Step 3.Take the time to provide as clear an idea as possible of just what your wishes and your beliefs are.

Step 4. Even if you think you already know, ask the person what he or she thinks about the different topics under discussion.

Step 5. Ask the Proxy hypothetical questions to confirm you both have the same understanding about what you do and do not want.

Step 6. Include the person's name in your Healthcare Proxy document, and ask him or her to affirm their agreement in writing.

Before having any discussion with the person you want to be your proxy, think through your values today - the things you care about. Then think about specifics.

Examples of values to think through include:

• What do you most value about your physical or mental well being?
• What are your fears regarding the end of life? For example:
• Being in pain.
• Losing the ability to think.
• Losing the ability to take care of yourself (such as dressing, bathing, and eating).
• Losing the ability to get around on your own.
• Being a financial burden.
• Would you want hospice care - care which only takes care of your comfort and stops fighting to cure your medical condition? (To learn more, see: Hospice Care.)
• What gives life meaning and purpose for you?
• What religious or spiritual concepts are overriding for you? How do those concepts translate into practical terms? (For instance, does your religion forbid blood transfusions under any circumstances? Does it require you to do everything humanly possible to prolong life so that turning off an assistive machine is is forbidden?)

For specifics to consider, see: What Would I Want To Happen?

Acting as your Proxy is not something to surprise someone with - not even an alternate proxy and not even if the person is your spouse. Some people, no matter how close they are to you, may have problems with the role and may not wish to undertake it.

As part of the request, consider mentioning what you would like the person to do for you. You don't have to be specific at this point. A general statement will do. For example: "I'd like you to think about being my Health Care Proxy. I trust you and I know you'll do what I need. We can discuss the specifics after you've thought about it. In general, I'd like you to know that if I become a vegetable, with no hope of recovery, I'd like you to pull the plug."

This will give the person time to think about your request and what it can mean.  Of course, if he or she understands the request and is agreeable, time to think about saying "yes" may not be needed.

We suggest starting with your general beliefs and desires. General statements give the Proxy a background against which to determine what you would have wanted if an unexpected situation occurs.

Once that's done, discuss as many procedures or treatments as you can - especially those which may be likely to be encountered if your health deteriorates from your condition. If your desires about any of those procedures or treatments seem to contradict your stated general beliefs, the two of you can discuss your reasons. This discussion will not only increase the chances that what you want will occur, it will also give your proxy more background to help answer questions that haven't specifically been discussed.

For example, Ron, a professional ball player, can state that he doesn't want his life extended if there is no quality of life. But what is quality of life to him? Is it the same as what his doctor would consider "quality of life?" Only a general discussion would help the Proxy understand that Ron wouldn't object to a pacemaker and a slower lifestyle without baseball, but would not be able to tolerate living in bed attached to a respirator.

Consider talking about the following subjects, as well as any other that may be important to you:

• Your religious beliefs.
• Your personal life philosophies - including how you do want to live your life, and how you don't want to live it. Give examples.
• How important it is to you for the proxy to consider the wants and feelings of your family and loved ones. If their feelings are important to you, who is the most important? Whose feelings are not important in this situation?
• About quality of life:
• Where would you draw the line below which you would not want to continue living?
• Avoid knee-jerk statements such as "I wouldn't want to live if I was blind/crippled/quadriplegic/whatever," without first thinking it through.
• Consider mental abilities as well as physical limitations.

While finances is not a treatment, consider your assets and how many of them you're willing to have spent on your treatment - or would you rather end the situation more quickly and leave assets to your heirs.

Don't be surprised if the discussion brings up things you haven't thought about, or even if it makes you question some of your decisions.

If you learn that the person's point of view is different from yours, is he or she still agreeable to going along with what you want and actively enforcing your wishes?

Even if he or she is willing, do you think your wishes will be carried out?

It is recommended that you not argue with your prospective proxy over the levels of care you do and do not want. In fact, if you find yourself having to defend your wishes to the proposed proxy, that could be a sign that you need to look for a different person.

It is advisable to confirm that the person truly understands your wishes. You can do this by taking a few minutes to engage in an exercise of "what if" with your Proxy. You can pose a few examples and ask the Proxy what he or she understands you would want in each instance.

For example:

• What if the doctors want to put you on a ventilator to make your breathing easier, and you will be on it for at least a week?
• What if the chances that you will come off the ventilator are 80%?  50%?  20%?

An alternative is to ask the person to repeat to you his or her understanding of your wishes. Rather than focus on the words used, try to be sure that he or she understands your basic values. Using the last example, if you say that you do not want to go onto a ventilator if there is little chance you will get off of it, then reasonable people would likely think that you would only reject a ventilator if there were only a 20% chance of your coming off of it, but would agree to a ventilator if the odds were 50% or 80%.

Only after you believe the person is clear about your wishes, and you are confident that the person is the right one to be your proxy, is it time to execute the document naming that person.

Be sure your proxy knows to confirm that, if you go into a hospital, a copy of your Healthcare Power of Attorney has been placed in your records "just in case."

It may be helpful to also put your general beliefs and wishes in writing so your proxy has a memory aid. Understand that the writing will be used as a guide only. It will have no legal authority of its own.

NOTE: The document for the Proxy is not the same as a Living Will which is a document we also recommend you have in case something in writing is needed by your Health Care Proxy to show proof of your intent.