What is a healthcare proxy and living will?

94. What is a healthcare proxy
and living will?

The death process in the United States has been dramatically
altered in the face of new medical technology
that saves and sustains life. With these advancements
come difficult decisions about when to use, and withdraw,
such treatments. Even with the best care available
today, there may come a time when your loved
one’s cancer has progressed beyond conventional treatments.

During this time, because of cancer spread to
the liver, lungs, or brain, he may not be mentally able
to make decisions regarding his own care. Family
members (or another person previously designated)
will then be asked to make medical decisions on the
patient’s behalf.

In order to facilitate the decision-making process and
address the communication, emotional, and sometimes
ethical issues that can arise, a legal system was established,
which varies from state to state. The general
term for the documents is an advance directive, placed
in the patient’s medical record, which describes his
wishes regarding various life-sustaining medical interventions
in the event that the patient cannot communicate
his wishes directly. This allows a person to take
control of his care and preserve his dignity in the event
of complicated situations.


Advance directive = A document in the patient’s record
describing his or her wishes regarding various life-sustaining
interventions in the event the patient cannot communicate
directly.


Patients can assign a healthcare proxy to help make
medical decisions if they are too debilitated to do so
themselves. A healthcare proxy (sometimes called a
medical durable power of attorney or a healthcare agent)
is an officially designated medical decision maker (identified
by a document or verbal identification) who acts
on the patient’s behalf if he becomes unable to make
medical decisions (due either to temporary situations or
to enduring ones, such as being permanently comatose).

Many states have family consent laws, establishing a
clear succession of family members to be identified as
surrogate medical decision makers, if a patient has not
otherwise named and documented a proxy. If you live
in such a state, it is particularly important that the
patient legally identify a healthcare proxy if he does not
want the state-designated family member to be his surrogate
decision maker. For example, the laws usually do
not recognize non-married partners (even for couples
who have been together for a long time) as part of the
succession. Instead, a parent or adult child, or a more
distant relative could be designated as the surrogate and
make crucial decisions about a person’s medical care.

For this reason, it is often best if the proxy is someone
with whom the patient has a close relationship and who
is aware of his feelings about extreme life support measures
in the setting of a terminal disease. In states that do
not have family consent laws, such as New York, it is
particularly important that patients have identified a
healthcare proxy and discussed their wishes with that
person, since a family member may not have the legal
right to make decisions on their behalf without having
been formally identified as the healthcare proxy.

Patients can develop a living will describing their
wishes regarding specific medical interventions toward
the end of life and can be very specific regarding individual
therapies that the person either desires or does
not desire to have. The use of prolonged ventilation
with a respirator, the placement of tubes for artificial
feeding, and the choice for cardiopulmonary resuscitation
(CPR) are common topics for clarification in a
living will. The information is documented in the
patient’s medical record and informs the decisions to
manage his care should the need arise. However, it is
still important for a patient to identify a surrogate
decision maker/healthcare proxy and discuss his or her
values and wishes with the surrogate and physician.
Living wills can help guide doctor and family decisions,
but rarely are they specific enough to apply to all
possible medical circumstances that may arise.

Living will = Legal document that specifies a patient’s
wishes in the event he or she becomes mentally
incapacitated.