Life Care Plans Part Three: To Whom It May Concern


Part 3 of a three entry mini-series discussing end of life healthcare and death choices. 

Now that we have discussed the when, why, how and what of end of life healthcare choices, it’s time to consider the “Who” with a look into medical proxies, the power they do and don’t have, and some things to consider when choosing your proxy.

Deciding on a healthcare administrator or medical proxy does not take away any of your current rights or choices.  A medical proxy can only make decisions for you if you are determined to be incapable of making them yourself.  Sometimes, this is clear: you may be unconscious or in a coma.  Other times, the degeneration is gradual and the determination is a little trickier.  Just because you are elderly or have a mental disease, that doesn’t automatically mean that your proxy will take over.  The doctor must bring in the medical proxy only if you can no longer understand, process and communicate healthcare decisions.

Once it is deemed necessary to use a medical proxy, they have almost total control over the healthcare decisions.  They cannot, however, make any decisions that conflict with directives you’ve left in your living will.  They also cannot make decisions that include commitment to a mental institution, convulsive treatment (like electroshock), psychosurgery (like lobotomies), abortion, and neglect of comfort care.  You can also trump their power by limiting the scope of their authority.

The medical proxy does not also automatically have power to make billing and financial decisions.  While you may very well decide to have the same person be your Financial Power Of Attorney, they can be to completely separate designations.

The decision of whom to choose as your medical proxy is not a light one.  While everyone has their own criteria, some of the suggested characteristics include someone who has no financial interest in your death as well as someone who lives relatively close to you.  While the financial interest assessment may seem harsh, you are protecting not only yourself, but also them from ever being accused of not doing their best to see through on your wishes.  Having them live close is not necessary but it does make things easier if you are in a sudden medical emergency like we talked about earlier.

This person should be someone who knows you well and that you’ve communicated with about your healthcare wishes.  It’s vital that they feel comfortable with your wishes, because they could potentially have to literally make a life or death decision for you.  You should also take into consideration whether you think that individual will have any residual guilt or emotional conflict that they continue to carry over having to make such momentous decisions – after all, this is going to be a rough time for them too.

While the advice on who to choose as your healthcare administer can be a little fuzzy, those youcannot choose is crystal clear.  Most states do not allow you to choose your doctor or anyone who works with or for them if they are not related to you.  Also, if you designate your spouse as your medical proxy and then have a finalized divorce, that choice is automatically revoked.  If you still want your ex-wife or ex-husband to act as your healthcare administer, you will need to draw up and sign new legal documents dated after the divorce.

In the end, only you can decide who is going to be the best person to be your healthcare administrator and why.  You can make the position easier, though, by leaving written guidelines and thoroughly discussing options beforehand.

Have you ever acted as a proxy?  Wait made it easier/more difficult for you?  Who would you NOT want to have as your proxy and why?

Thanks to DailyInvention and TheDaringLibrarian for use of their photos.

~Laura

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