Health Care Agents: Appointing One and Being One
Why should I appoint a health care agent?
When you appoint a health care agent, you are designating a person to be
your voice and your advocate. Because making medical decisions is rarely
simple, it is difficult to foresee all of the possibilities in advance. Having
an agent permits the same kind of flexible decision making that would occur if
you were able to talk with your doctors, ask questions, weigh the benefits and
burdens of the treatments involved, and make decisions based on specific
An agent usually is permitted to make decisions in a wide range of medical
situations, not just those involving end of life, and can respond to
unanticipated events. Decisions can be based not only on what you may have
expressed, either verbally or in writing, but also on the knowledge of you as a
person. Your agent can consent to treatment and refuse treatment. For example,
an agent might consent to a trial of treatment and, if it does not have the
expected benefit, authorize its withdrawal. Your agent can take into account
other concerns you may have, such as the quality of life that matters to you,
your values or religious views, and other personal concerns that might affect
In addition, an agent can advocate on your behalf. If a physician is
unwilling to honor your wishes, the agent can seek another physician, go to the
administrator or ethics committee on your behalf, or take other actions to see
that your wishes are respected. Your agent can have access to your medical
records and can seek a second opinion for you. Your agent also can see that you
receive appropriate pain management and palliative care.
How does appointing a health care agent differ from creating a living will?
A living will is a document that provides specific instructions about
end-of-life care. It may be called a medical directive, declaration, or
something else, but its purpose is to give specific directions or guidelines
for the care you want to receive. In contrast, a medical power of attorney is a
document in which you designate a person to make medical decisions that may or
may not be limited to end-of-life care.
Generally, the appointment of a health care agent permits more flexible
decision making. Living wills, when used without a health care agent, are more
limited as a tool for decision making because they cannot address unanticipated
medical situations and might be difficult to interpret in a particular
If I appoint an agent, should I prepare a living will?
In most states it is not necessary to prepare a living will or other
directive if you have appointed a health care agent; however, living wills can
still be useful. If the agent must make a difficult decision, the instructions
you have given in your living will can reassure your agent that your wishes are
Furthermore, if the person you appointed to be your agent becomes
unavailable to speak for you, your living will can provide useful guidanceto
your caregivers. A thoughtfully prepared living will can be a valuable
complement to the appointment of an agent.