Health Care Agents

Introduction Appointing a Health Care Agent Being a Health Care Agent Glossary

Being a Health Care Agent

Why would I want to be a health care agent?

Accepting the appointment to be a health care agent is a way of affirming the importance of your relationship to the person appointing you. However, accepting an appointment requires thoughtful consideration about whether you can fulfill the role appropriately. Acting as a health care agent brings significant responsibilities and should be viewed as an honor to be given such trust.

There also are practical reasons for accepting formal appointment as an agent. If you are the closest relative to the patient, you can expect to be the person that health care professionals will look to for consent or decisions if the patient cannot make them. However, some state laws limit this informal decision-making process, particularly in cases of decisions to forgo or withdraw treatment. Without a formal appointment you may be able to consent to treatment but not refuse it or have it stopped, even if you know it is unwanted. To stand by helplessly watching someone you love be treated in a way you know that person would not have wanted can be a very painful experience.

If there is a conflict among family members and no agent has been designated, medical providers will normally continue all treatment until the conflict is resolved. Even if you are the person who knows the patient best and the one in whom the patient has confided, you may be unable to speak for the patient unless you are the legally designated agent. You may be excluded from decisions, particularly if you are not a close relative. It is not uncommon today for a friend to be closer to a person than family members who may live far away. If you are a formally-appointed health care agent, your authority has priority over all others, including family members.

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.

<<Previous | Next: How do I make decisions as a health care agent?