Do you have questions about the language behind advance care planning? A critical part of the process  is choosing someone who will represent you in case you can’t represent yourself. But the terms used to refer to these representatives, and the forms needed to appoint them, can vary — especially by state or region. 

This blog explains key terms and provides an introduction to healthcare proxies, the process of selecting one, and resources for getting started.

Key terms explained:

• Advance Directive: A legal document that describes your wishes, values, and priorities for your healthcare. It typically includes a Living Will (which expresses your wishes) and a Healthcare Power of Attorney, Medical Power of Attorney, or Healthcare Proxy form (which identifies who will speak for you). Learn more here. 
• Healthcare Power of Attorney, Medical Power of Attorney, or Healthcare Proxy: A legal document that varies by state and grants authority to someone to make healthcare decisions on your behalf.  You can also specify in this document if there is anyone you don’t want to be involved in your care or allowed to visit you.
  
  Though a healthcare power of attorney, medical power of attorney, or healthcare proxy is the name of the document, these terms are also sometimes used to refer to the person who is appointed to serve in this role. 
• Power of Attorney: A legal document that varies by state and grants authority to someone to handle your financial matters. A power of attorney form must be signed, witnessed, and notarized by another adult. Though a power of attorney is the name of the document, it is also sometimes used to refer to the person who is appointed to serve in this role. 
  • A Durable Power of Attorney remains in effect if you become incapacitated and it ends when you die.
  • A Limited Power of Attorney gives someone the authority to make only some decisions for you in certain circumstances. 
• A Healthcare Proxy, Agent, Surrogate Decision Maker, Representative, Medical Power of Attorney, or Durable Power of Attorney for Healthcare: Different names that refer to the trusted person who is legally designated to make healthcare decisions for you if or when you are unable to make them yourself. Throughout this blog, we will use the term “proxy” to refer to this individual. 

Who is a healthcare proxy and how do I select one?

If you had surgery or were facing an emergency, who would you want by your side? Who would you trust to speak on your behalf? 

Your proxy should be an adult you trust — whether a family member, friend, neighbor, or anyone who knows what matters to you and can stand up for you if you are unable to communicate for yourself. However, you cannot appoint your primary care physician or any other healthcare practitioner involved in your care unless they are related to you. 

Here are some qualities to look for in a proxy:

• They are assertive. You want someone who is comfortable speaking with healthcare providers and advocating for you.
• They are comfortable having difficult conversations and discussing topics like illness and death.
• They will respect your decisions and wishes for your care. They understand where you’re coming from, are familiar with your advance directive, and are willing to honor your requests.
• They live nearby. In a crisis, having someone local is often important.

When discussing your request with a potential proxy, explain what you are asking of them, share why you picked them, and let them know there is no financial liability attached to this role. Ensure they understand what the role entails and that they are comfortable serving in it. Once you’ve chosen a proxy and they have agreed, it is recommended to let others know your choice in order to minimize surprises when an emergency arises.

You can also choose an alternative proxy in case your primary proxy is unavailable or unable to serve in this role at any point. 

What does a proxy do?

A proxy is empowered to talk with your healthcare team, access your medical records, and make decisions on your behalf — such as when to stop or start care. That’s why it is essential to talk with your proxy about your values, priorities, and goals for your care. They should know what quality of life means to you and what medical treatments you would want and not want in different situations.  

Your proxy and healthcare providers will be guided by your written wishes in your advance directive, but the more your proxy understands you and your perspective, the more they will

be able to make the choices you would have wanted in unanticipated situations.

Also, your advance directive will specify the authority given to your proxy and when it becomes effective — either immediately or once your healthcare team has determined you no longer have decision-making capacity. 

What if I don’t know who to ask to serve as a proxy?

If you’re finding it hard to identify someone to serve as your proxy, you’re not alone. Remember that your proxy doesn’t have to be a family member or friend. You can ask a neighbor or a member of a group or community you are part of, such as a book club, senior center, church, or synagogue.

Learn more about potential proxies on page 14 of the Compassion & Choices End-of-Life Decisions Guide & Toolkit. 

What if I don’t choose a proxy?

Laws can vary by state, but generally, your next-of-kin will be called on to serve as a proxy if you haven’t identified one. The order is typically: 

1. Legal guardian appointed by a judge, though this is rare
2. Spouse
3. Children (equal among biological and adopted, not stepchildren)
4. Grandchildren
5. Parents
6. Siblings and half-siblings
7. Extended family

In addition to making decisions for you, your next-of-kin will also have the right to access your assets, finances, and health information.

If you don’t choose a proxy and no close family is available, some state laws will have your healthcare providers ask a distant relative or non-family member to serve as your decision-maker. Other states will instruct your healthcare providers to make decisions for you.

For people in LGBTQ+ relationships, healthcare institutions and the state you live in may not recognize your married or unmarried partner as your next-of-kin. Life partners and chosen family may also not be given access to you if you become incapacitated in a facility. For this reason, it is especially important for LGBTQ+ people to complete a healthcare proxy form.

Get started

If you haven’t yet created an advance directive or designated your proxy, now is the time! Find your state-specific advance directive form here. Here are some additional resources to help walk you through the process:

• Read this guide to Being a Surrogate Healthcare Decision-Maker.
• LGBTQ+ people can face additional challenges in healthcare settings. We created this LGBTQ+ Advance Care Planning Toolkit with SAGE to address these concerns and provide guidance on designating a proxy and making other important decisions.
• Browse additional Compassion & Choices resources to prepare yourself and your loved ones for the end of life.

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