A health care proxy (also known as a “durable power of attorney for health care,” “medical power of attorney” or “appointment of a healthcare agent”) is a document that allows you to appoint another person (a “proxy” or “agent”) to make health care decisions for you if you can not speak for yourself.

Naming a proxy is one of the most important things you can do to ensure that you always get the health care you would prefer.

You do not have to be terminally ill for a health care proxy to go into effect; you only need to be unable to communicate your wishes due to temporary or permanent illness or injury. In some cases a doctor may have to certify that you are “incapacitated.”

If you regain the ability to make your own decisions, you will again be able to speak on your own behalf. You should look at the health care proxy document periodically to ensure that the person you originally chose as your agent is still the person you would most prefer. If your preference changes, you can change the document.

As long as you give your agent permission, he or she will have the flexibility to make most treatment decisions and access any medical records that you would. It is critical to appoint someone

• who you trust;

• who knows you well and understands your medical preferences;

• who will be assertive in making decisions; and

• who will honor your wishes.

Some things you should discuss with your agent:

• personal attitudes towards health, illness, dying and death;

• religious beliefs;

• feelings about doctors and other caregivers;

• feelings about palliative (comfort) care versus life-sustaining treatments like artificial nutrition and hydration; and

• preference for what treatment you would want if you were unconscious for a long period of time and not expected to recover.

Where issues arise that have not been discussed, the guiding principle for the agent is to act in the patient’s best interests.

Ideally, you should have a health care proxy and a “living will” that states your preferences for end-of-life treatments. The living will can act as a guide for your agent as well as for physicians. Many states combine proxies and living wills into one “advance directive” document.

Some important things to know about health care proxies:

• Health care proxy documents generally allow you to name a second person who can act as your backup “agent” if for some reason your primary agent cannot fulfill his duties. You should always name a backup agent.

• If you do not appoint a health care proxy and can no longer make health care decisions, state law decides who can make decisions on your behalf. That power may go to a doctor, family members or hospital administrators.

• If there is no one you trust to make health care decisions for you, you should not name anyone as your agent, and instead create a living will to advise your physicians about your preferences.

• A health care proxy generally only gives your agent the power to make medical decisions. Whether changing your health insurance (such as your Medicare drug plan) is considered a financial decision, not a medical decision will depend on state law. In many states, you may need to appoint a power of attorney for this.

  To find out more about how "power of attorney" works, click on the link in the GO TO box.

• You do not need a lawyer to write a health care proxy. You can use a standardized form and tailor it to your needs but make sure that it meets all of your state’s legal requirements. Discuss the document with your health care agent and your loved ones.

For more information on how to how to create a health care proxy document, click on the link in the GO TO box.

For advice on how to choose and talk to your health care proxy, go to the American Bar Association’s (ABA) Consumer Tool Kit for Health Care Advance Planning. Click on the link in the LINKS box.

To find out how a living will works, click on the link in the NEXT box.