Hospice of the Comforter

An advance directive is a legal document regarding end-of-life choices, with two important components. The first, and probably most important part, is choosing a healthcare surrogate: a person or persons who could make medical decisions for you if there is ever a time that you are not able to speak for yourself.

The other major part of an advance directive is the Living Will, in which you can explain what medical interventions you would want or not want when you are seriously ill, or close to the end of your life. This blog discusses considerations when choosing a healthcare surrogate, and some information for such surrogates, in terms of their rights and responsibilities.

It is a good idea to choose a primary healthcare surrogate, as well as two other back-up surrogates in case your primary choice is unavailable. At least one of these three people should live locally, since medical decisions are often made very quickly, especially in emergency situations. The healthcare surrogate must be at least 18 years old, and should NOT be one of your healthcare providers, including the staff at any long-term care facilities, hospitals or physician’s offices.

Also, this person(s) should be someone who is likely to be available long into the future. Other important considerations in choosing your surrogate are personality traits, like assertiveness. Is this a person who would be able to stand up against authorities or bureaucracies and advocate for your rights without feeling intimidated? In other words, choose someone who has some moxie. Does this person know you well, and understand what is important to you?

Before you make your final decisions on who should be your healthcare surrogates, sit down with each person and have a fairly tough talk on what your treatment wishes would be, and if they feel they would be able to make these difficult decisions for you. Would doing so compromise their values in any way? Would they be able to manage conflicting opinions between family members, friend and medical personnel?

Although we typically choose a spouse or family member to take on this role, they are not always the best choice, as they may be too emotionally involved. Once you have made your choices, this information, as well as your Living Will, should be shared with other close family members, your physicians, your lawyer, and maybe your faith community.

Your healthcare surrogates have the authority to make any and all medical decisions you would make for yourself if you were able. This includes:

• Receiving the same medical information the individual would receive.
• Conferring with the medical team.
• Reviewing medical charts.
• Asking questions and getting explanations.
• Discussing treatment options.
• Requesting consultations and second opinions.
• Consenting to or refusing medical tests, medications or treatments, including life-sustaining treatment and/or organ donation.
• Authorizing admissions or transfers to another physician, organization or institution, including assisted living facilities, hospitals, hospices and nursing homes.
• Taking any legal action needed to carry out a person’s wishes.
• Applying for Medicare, Medicaid or other insurance benefits the person might require.

An excellent guide for healthcare surrogates can be found here.

Choosing a healthcare surrogate wisely and communicating effectively with them and the rest of your family is one of the greatest gifts you can give your loved ones and yourself. Your family and friends will not have to guess what you want or make hard choices without knowing your wishes. Although agreeing to be a healthcare surrogate involves much responsibility, most people in this position are glad that they can be there for you in difficult moments, and fulfill your important wishes.

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