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Health Care Agents: Appointing One and Being One

What are my responsibilities as a health care agent?

As the health care agent you have the power to make medical decisions if the patient loses the capacity to make them. Unless your authority to act is limited by the patient or the state law, you normally can make all medical decisions for the patient, not only end-of-life decisions. In most states, as the health care agent you can also speak for the patient even if he or she becomes temporarily incapacitated as might occur after an accident. Generally, you may speak for the patient only as long as the patient is unable to make decisions.

You need to read the state forms and the instructions carefully to find out if there are any limitations upon your authority to make health care decisions. For example, in a few states your authority to make end-of-life decisions is limited to circumstances addressed in the document. Some limit the agent's ability to make decisions related to psychiatric hospitalization or shock treatment. A few states require that the agent have some specific knowledge about the patient's wishes regarding artificial nutrition and hydration or other specific treatments.

One of an agent's most important functions is as an advocate for the patient. Advocacy can involve asking to see medical records, meeting with the physician to get information about the patient's diagnosis (what is wrong with the patient) and prognosis (what is the likely outcome of this medical condition, with treatment and without treatment), and getting other information that is needed to make decisions about treatment.

Physicians do not always understand the authority of an agent. Although most physicians understand that patients are entitled to information, they may not realize that the agent is entitled to the same information that the patient could receive. Therefore, as the agent you may need to be assertive and persistent in seeking information and in speaking up on the patient's behalf.

However, if you are respectful but firm, you should be successful in having your authority recognized. It is important for you to remember that you have the legal authority to speak for the patient, not the physician, nurses or other health care professionals.

There are others who can be helpful to you. There may be a patient representative, nurse, or social worker who can help you advocate for the patient. In addition, outside organizations such as the National Hospice and Palliative Care Organization can provide valuable information and advice. In the back of this booklet, you will find resources that also can be useful.

How do I make decisions as a health care agent?

Generally, you will be required, as far as possible, to make the same medical decisions that the patient would have made. To do this you might need to examine any specific statements that the patient made (either orally or in writing, such as in a living will), as well as consider the patient's beliefs and values.

If you have no information about what the patient would want, you must act in what you believe would be in the patient's best interest, using your own judgment. To arrive at that decision, you might ask the patient's doctors what kind of benefits and burdens might result from the treatment; you can draw on knowledge that others have about the patient and on their opinions; or you can ask others what they would want if they were in such a situation. However, the more you and the patient have talked, the less likely you will be in the dark about what the patient would want.

WebMD Medical Reference from the National Hospice and Palliative Care Organization

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