the most serious of responsibilities to be bestowed upon
you: the power to make medical decisions for your loved
one in case he or she canít. Itís called being a
health care proxy, and it means you can make decisions
and take actions that your loved one would if he or she
encompasses talking with your loved oneís medical team
about treatment choices and deciding on a course of
action. It may also entail making end-of-life decisions.
how do you take on such a huge responsibility? Here are
CAN SAY NO
someone asks you to be their health care proxy, think it
through carefully. Understand that you donít have to
may be hard enough coping, even without the added
responsibilities of making health care decisions,"
the American Bar Association says in its guide Making
Medical Decisions for Someone Else: A How-to Guide.
"But it is an important way to help someone you
are three kinds of health care proxies: agent, surrogate
and guardian. But in all cases, a proxy is a person who
can make health care decisions for someone else.
I see with my clients is that thereís a lot of
confusion because there are several documents
involved," said Marvin Blum, an estate planning
attorney at the Blum Firm PC in Fort Worth and Dallas.
are the key documents you need to know:
power of attorney ó In this document, you designate a
person and perhaps one or two alternates who will make
medical decisions for you when youíre unable to do so
to physicians ó A person uses this legal document,
also known as a living will or physicianís directive,
to make known his or her wishes regarding
life-prolonging medical treatments.
physicianís directive does not designate an agent but
rather allows a person to express their wishes on
end-of-life decisions," said Brian Fant, an elder
law attorney in Dallas. "It allows an individual to
express his or her preferences in advance in the event
they are unable to speak for themselves when faced with
either a terminal condition or irreversible condition,
both of which are specifically defined in the
a critical document.
is the only document that gives the patientís family
advocate a voice in the decision-making about pulling
the plug," said Michael Wald, an estate planning
and elder law attorney at Underwood Perkins PC in
Dallas. "Without it, the advocate may be listened
to, but their input isnít seriously considered by the
hospital ethics committee that makes the final
end-of-life care decisions."
waiver of authorization ó This legal document allows
an individualís health information to be disclosed to
a third party. The waiver is one of the patient-privacy
measures contained in the federal Health Insurance
Portability and Accountability Act of 1996.
important that you understand your loved oneís wishes
time discussing the wishes of the individual at the time
you agree to serve as the agent," Fant said.
"Discuss religious and moral beliefs to know how
they would make decisions on medical care.
not be afraid to address the issues," he said,
adding that the best time for a frank discussion is when
the documents are signed.
everything down and keep it for future use.
BEGIN OPTIONAL TRIM)
said heís drafting documents for a client that directs
his proxy to consider his clientís Roman Catholic
faith and to turn to the church for guidance.
draft of proposed language in the clientís medical
power of attorney directs that health care decisions be
made "in accordance with the principles and
authoritative teachings of the Catholic Church."
Fish Jr. said heís had "the talk" with his
87-year-old father, Curtis Fish, who has dementia and is
living in a senior community.
brother holds the main medical power of attorney for his
father. But Fish is the alternate and makes the primary
medical decisions for his dad because they live in the
hope youíre making the right decision," said
Fish, 58. "We had that conversation several years
ago when we were drawing up the do-not-resuscitate order
and those kinds of things. Itís one of those things
that we hope we never have to use."
ACCESS TO RECORDS
should have access to your loved oneís medical records
and any information you need about the patientís
health or health care.
for clear explanations so you can understand the patientís
medical condition and what treatment options are
care teams at Baylor Health Care System help those
charged with making medical decisions reach a comfort
level about their actions. Itís a service they provide
to patients and their families.
of us as we approach the end of life lose the ability to
communicate our wishes," said Dr. Robert L. Fine,
clinical director of the Office of Clinical Ethics and
Palliative Care at Baylor. "Appointing a surrogate
is one way to deal with that."
he said that often surrogates donít know what the
own anecdotal experience over 30 years of conversations
with surrogates is that they frequently tell me that
they and their loved one never discussed treatment
preferences," Fine said.
there are several surrogates, they often disagree about
what their loved one would want, and that is stressful
not only for the family member but also for the medical
team, he said.
stress is significantly lower when the patient gives the
surrogate written guidance with a living will,"
said his father wants to be treated with respect as he
approaches the end of life.
spent a lot of time with him, and he talked about how he
wanted things to be handled," Fish said.
said his father told him, "I donít want to be
stuck on a machine where I wouldnít recognize my
wanted to keep his dignity, both in health and
death," Fish said.
isnít that what youíd want for your loved one?