Appointing a Health Care Agent

1. Who can serve as my agent?

Your agent can be almost any adult whom you trust to make health care decisions for you. It can be a close family member or a good friend who is willing to assume that responsibility on your behalf.

The important thing when appointing an agent is to make sure he or she understands your wishes about the use of medical treatment, and is willing to respect them and to be assertive if necessary. Not everyone is comfortable making these kinds of decisions, and your agent may have to be persistent in order to have your wishes respected. Therefore, it is essential that you talk to the person before appointing him or her, even if it is your spouse, adult child or other family member.

2. Who cannot serve as my agent?

Under most state laws, you cannot appoint your attending physician as your agent, and in some states, your agent cannot be any other health care worker caring for you in a medical facility.

3. Can I appoint more than one agent?

You should not (and in many states you may not) appoint more than one person to act at the same time, because it can cause conflicts and confusion. The result may be that no decision is reached.

Parents sometimes wish to appoint all of their adult children to act together as the agent, to avoid "playing favorites." Instead, you could ask your children to decide among themselves who should be the agent. Practical considerations such as location often make the answer obvious; sometimes one is more willing to take on this role than another.

You can appoint one or more alternate agents. If the first person you appointed is unwilling or unable to serve — for example, if he is ill — then the next person is called upon to act as your alternate agent, and so on down the list of people you name as alternates.

Remember, in many states, appointing more than one person at a time can make the appointment invalid.

4. What should I tell my agent?

Your agent needs to know when and how aggressively you would want medical treatment applied.

For example, if you had a massive stroke, would you want to receive aggressive treatments (such as mechanical ventilation, antibiotics, tube feeding), for a time, but have them stopped if there were no improvement? What kind of treatment would you want if you were in a permanent coma or persistent vegetative state: a ventilator? tube feeding? comfort care only? What are your views on artificial nutrition (tube feeding)? Do you want to receive it no matter what your medical condition? on a trial basis? never? If your heart stopped beating, under what circumstances would you want doctors to try to resuscitate you (using CPR)?

Talking to your agent means discussing values and quality of life issues, as well as treatments and medical situations. Since there may be situations that you could not anticipate, your agent may need to base a decision on what he or she knows about your values and your views of what makes life worth living. These are not simple questions, and your views may change. For this reason, you need to talk to your agent in depth and over time.