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Health Care Agents: Appointing One and Being One

How can I talk about these issues?

Talking about end-of-life issues can be difficult for anyone. One way to approach the subject is to talk about why you have decided to name an agent.

For example:

  • Did a particular event cause you to make the decision?

  • Did an article you read in the newspaper or something that happened to a family member make you think about it?

  • Is the decision part of a broader effort on your part to prepare for the end of life, for instance making your last will and testament for distribution of your property?

  • What is motivating you to take these actions now?

Sometimes sharing your personal concerns and values, your spiritual beliefs, or your views about what makes life worth living can be as helpful to your agent as talking about specific treatments and circumstances. For example:

  • How important is it to be to be physically independent and to stay in your own home? Independence can be extremely important to some and maybe less important to others.

  • What aspects of your life give it the most meaning?

  • How important would it be for you to be able to recognize people or interact with them?

  • What are your particular concerns about dying? About death?

  • How do your religious or spiritual beliefs affect your attitudes toward dying and death? Would you want your agent to take into account the effect of your illness on any other people?

  • Should financial concerns enter into decisions about your treatment?

  • Would you prefer to die at home if possible?

These are not simple questions and your views may change. It is important that you review these issues with your agent from time to time.

How does my agent make decisions?

Under most states' laws your agent is expected to make decisions based on specific knowledge of your wishes. If your agent does not know what you would want in a particular situation, he or she should try to infer your wishes based on their knowledge of you as a person and on your values related to quality of life in general. If your agent lacks this knowledge, decisions must be in your best interest. Generally, the more confident the agent is the decisions will accurately reflect your wishes, the easier it will be to make them.

In a few states, the law limits the agent's power to refuse some treatments in certain circumstances. State law, for example, may limit decisions to what the patient has specifically stated in the appointing document or in other documents such as a living will. You should carefully review your state documents.

What if I know that members of my family disagree with my wishes?

To ensure that your wishes are followed, be certain that the person you appoint to be your agent understands your wishes and will abide by them. Your agent has the legal right to make decisions for you even if close family members disagree. However, should close family members express strong disagreement, your agent and your health care professional may find it extremely difficult to carry out the decisions you would want.

  • If you foresee that your agent may encounter serious resistance, the following steps can help: communicate with family members you anticipate may object to your decisions. Tell them in writing whom you have appointed to be your health care agent and explain why you have done so.

  • Let them know that you do not wish for them to be involved with decisions about your medical care and give a copy of these communications to your agent as well.

  • Give your primary care physician, if you have one, copies of written communications you have made.

  • Prepare a specific, written living will.

  • Make it clear in your documents that you want your agent to resolve any uncertainties that could arise when interpreting the living will. A way to say this is: "My agent should make any decisions about how to interpret or when to apply my living will."

WebMD Medical Reference from the National Hospice and Palliative Care Organization

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