What is a health care agent?
A health care agent (also known as surrogate decision-maker or or proxy decision-maker) is the person you choose to make decisions about medical care on your behalf. Your agent is someone who would speak for you if you were unable to make or communicate your own wishes for health care.
Your health care agent does not need to know a lot of medical information; your agent just has to know you. It is important that your agent is well informed of your wishes and agrees to honor these wishes even if they are different from his or her own.
Who did you select to be your agent?
Choose only one agent
You should choose only one person to be your health care agent; this person is called your primary agent (or agent). In the event that you can not communicate, your agent will share your values and wishes with the physicians and nurses taking care of you. One reason there can be only one person appointed as your agent is to lessen the chance of any disagreements between people, and allow decisions to be made more clearly.
Then choose two alternate agents
We encourage you to choose two alternate agents. Your first alternate agent would become your agent only if your primary agent were unavailable or unable to serve, such as if he or she:
- Can not be reached during your medical crisis or
- States that he or she is emotionally or physically unable to serve in the role of your agent or
- Has died
Your second alternate agent would only become your agent in the event that neither your primary or first alternate agent are available to serve as your agent.
Become familiar with responsibilities of your agent
In the state of California, a health care agent is authorized to make decisions about such as these:
- Make choices about your medical care, including decisions about tests, medicines and surgery. It also includes decisions to provide, not provide, or stop all forms of health care to keep you alive, including artificial nutrition (food) and hydration (water).
- Review or allow the release of medical records.
- Decide which health care providers and organizations can provide your medical care.
- Arrange for and make decisions about the care of your body after death (including autopsy).
Your agent speaks on your behalf
Usually, the agent manages your care in the event that you are unable to make decisions or communicate your desires. However, some people choose to have their agent make health care decisions for them even when they are still able to make decisions on their own. You might make this choice if you are diagnosed with a progressive illness such as Alzheimer’s disease.
If you wish to limit some authority of your chosen agent it is best to specific in your Advance Health Care Directive.
An important part of life care planning is appointing a health care agent to make your health care decisions if you could not make them for yourself.
Many people select a close family member, but you are free to pick anyone you think could best represent you.
A good health care agent is someone who knows you well, who you trust to understand your values, and who can act according to your wishes. A good agent should also be someone with the ability to understand information and make good decisions in stressful situations.
Who cannot be your health care agent
There are some types of people who you cannot choose to be your agent. These may depend on the state in which you live. For instance, in California, you may not choose your doctor or any employee of Kaiser Permanente (or other health care organization where you receive care) unless this person is your relative or co-worker.
Selecting a health care agent is a big decision and deserves some careful thought. Here are some questions to ask yourself before choosing a health care agent:
- Who knows me really well?
- Who will honor my wishes even if they are different from his or her own?
- Who is typically available when I need them?
- Who has shown in the past that they are concerned with my happiness and well-being?
- Who is able to understand complex situations?
- Who is good at making difficult decisions even when emotions are involved?
Once you decide who to choose as your agent
Once you decide who to choose as your agent, you will want to make sure that this person is willing to accept this responsibility. You will also want to ensure that this person is willing to follow the values and instructions that you have shared with them. You should inform your other loved ones and Kaiser Permanente who you have chosen to be your health care agent. To make this choice official, identify your agent in your Advance Health Care Directive.
Designating a health care agent is just one step in the process of life care planning.
Thinking about your values and communicating them to those around you is another crucial step. Some people don’t have a person to appoint as an agent or choose not to name an agent. If you decide not to appoint a health care agent, it is even more important to make your values, priorities and health care wishes known.
Effective ways to inform others of your wishes
You can communicate your wishes in several ways:
- You can use the Advance Health Care Directive to explain the care you would or would not want in certain situations. You will want to be as specific as possible to give your doctors information they need to guide decisions about your medical care in the event that you are incapable of making or expressing your wishes.
- Have discussions about values and health care choices with friends, family, and others in your life. These discussions inform others of your desires so that they can participate in decision-making on your behalf if needed.
- Communicate your values and priorities to your doctor regularly so he or she has an understanding of what care you would want for yourself.
Once shared with your physician, your medical wishes will be placed into your medical chart. That way, if ever needed in an emergency situation, your physician would know your preferences regarding medical intervention.
Talking with your agent
General tips for starting the conversation with the person you want to be your agent
How you choose to approach the subject may depend on who you are selecting. For example, you might have a very different conversation with your adult son or daughter than you would have with a trusted neighbor. So, these tips can be customized to work for you:
- Pick a good time and a comfortable place to have a conversation. You don’t want to be rushed or interrupted.
- It is a good idea to “set the stage” at the beginning of the conversation by mentioning that you have something important you need to speak about.
- Describe what a health care agent is and does, the importance of having one, and tell the person why you want her or him to be your agent.
- Let the person know that you understand that this is a serious request you are making and that you don’t want him or her to feel forced to serve as your agent if this is not something they feel able to do.
- Explain that if he or she agrees to be your agent, you’d like to have a discussion about your values and wishes for future health care. You would do this so that if he or she ever had to speak on your behalf, there would be no need to guess what kind of care you would want.
- Give him or her time to thoughtfully consider what you are asking and to provide you with an answer at a later point in time.
Reviewed by: John W Prochnow, November 2017