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Healthcare Agents: Choosing One and Being One

 
Healthcare Agents: Choosing One

A healthcare agent is someone you designate to make medical decisions for you if, at some future time, you are unable to make decision’s yourself. Your agent can be a close relative or a personal friend, but should be someone who knows you well and whom you trust. Your healthcare agent should be a person who knows your wishes about medical treatment and who is willing to take responsibility to ensure your wishes are followed. In most states, your agent can make decisions any time you lose the ability to make a medical decision, not just decisions about the end of life.

Ideally, your agent should be someone who is not afraid to ask questions of the healthcare professionals in order to get information needed to make decisions. Your agent may need to be assertive to ensure that your wishes are respected. Your agent will need to know as much as possible about your wishes and values regarding the use of medical technology. Not everyone is comfortable accepting this sort of responsibility; therefore, it is very important to have an honest discussion with the person you plan to appoint before you make the appointment.

Selecting an Agent

• Select someone whom you trust and who understands your decisions.
• Because you are asking your agent to accept significant responsibility, be certain to ask your agent if he or she is willing to act on your behalf. Not everyone is able to be an effective agent.
• Talk to your agent about your wishes regarding end-of-life medical treatment. Even family members may not know how much treatment a loved one would be willing to accept near the end of life. Talking clarifies what you want and diminishes an agent's potential guilt and anguish over whether he or she is doing the right thing.
• Prepare and sign the appropriate advance directive forms for your state. Keep the original and give copies to your agent and alternate agents, family and doctors and have it placed in your medical record.

Talk with your healthcare agent about your end-of-life wishes.

Your healthcare agent needs to know about the quality of life that is important to you and when and what medical treatments you would want. Talking to your agent means discussing values and quality-of-life issues as well as treatments and medical situations. Because situations could occur that you might 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.

The following questions may help you discuss these issues with your healthcare agent:

• Are there treatments you particularly want to receive or refuse?
• What are you afraid might happen if you can't make decisions for yourself?
• Do you have any particular fears or concerns about the medical treatments that you might receive? Under what circumstances?

The following questions may also help you to clarify your wishes to your healthcare agent:

• What are your views about artificial nutrition (food) and hydration (fluid)?
• If your heart stopped, under what circumstances would you want doctors to use CPR to try to resuscitate you?
• Would you want to receive treatments such as mechanical ventilation, antibiotics, or tube feeding for a time, but have them stopped if there were no improvement in your condition?
• Do you want to receive these types of treatment no matter what your medical condition? On a trial basis? Never?

Benefits of Having an Agent

• The agent knows you and understands your wishes about medical treatments. He or she can make decisions in situations you might not have anticipated.
• An agent has flexibility. He or she can talk with your physicians about your changing medical condition and authorize treatment or have it withdrawn as circumstances change.
• If you have prepared a living will, your agent can interpret it in situations that were not foreseen. Be sure to make clear in your living will that your agent should make decisions on how to interpret it or when to apply it.
• Your agent can advocate for you. If healthcare providers resist following your wishes, your agent can negotiate with them and take any other necessary steps to see that your wishes are honored.

Healthcare Agents: Being One

Advocating for your loved one can be a difficult task. You should ensure that you are comfortable taking on this responsibility and have ongoing conversations with your loved ones about their wishes for end-of-life care. One of your most important responsibilities will be to communicate with your loved ones healthcare providers to ensure your loved ones wishes are honored.

How to talk with a doctor if you are a healthcare agent:

• Establish open communication with the doctor. 
• Make an appointment to speak about your loved one's care.
• Be assertive in expressing your wishes. Clearly state the reasons behind your requests without being hostile.
• Ask questions. To be effective and to make informed decisions, learn as much as possible about your loved one's condition and prognosis.
• Ask about the goals of the treatment plan - often. A physician's definition of recovery can be different from what is acceptable to you or your loved one. Seek the assistance of a social worker or patient representative if necessary. Such professionals can help improve communication between you and the physician.
• Don't be afraid to speak to the facility's administration. If the physician is unresponsive, go directly to his or her superiors, including the chief of medicine, risk manager, hospital lawyer or administrator.