What is a Health Care Proxy or Surrogate, and Why do I Need One?

Daniela Fortino

What is a health care proxy, and why do I need one?

What happens if a person becomes incapacitated due to an accident or illness? Who makes decisions on their behalf? This is where a health care proxy, sometimes called a health care agent or a health care surrogate, can bridge the gap. Their role is to convey a person’s wishes if they become medically incapacitated. Here is everything you need to know about a health care proxy or surrogate and why you need one.

What is a healthcare proxy?  

A health care proxy is an individual appointed to make health and medical decisions for a person when they cannot make them for themselves. This refers to any period in life when a person cannot communicate their health decisions. This includes situations that cause mental impairment towards the end of life or after a severe head injury from an accident.

Appointing a health care proxy is part of creating an advance directive, which also outlines a person’s health care wishes and choices to be followed when they cannot make these decisions themselves.

These documents must be discussed and written when a person is still mentally and physically capable of making those decisions. In some Canadian provinces, advance directives do not need to be documented or signed by a lawyer. However, a written document minimizes misinterpretation or disputes. See advanced directive document kits by province.

A health care proxy may also be referred to as:

• Health care surrogate
• Health care agent
• Health care representative
• Health care attorney-in-fact

What are the rights and responsibilities of a health care proxy?

Without an advance directive, medical decisions are at the discretion of the health care proxy. If one exists. Health care proxies are legally required to follow the wishes outlined in the document.

A substitute decision-maker may be chosen in the absence of an advance directive and an assigned health care proxy. The order of priority varies depending on the province but typically falls to the next of kin.

The rights of the health care proxy can vary depending on province or country. However, the most common rights and responsibilities include:

• Access to medical records.
• The right to consent to or refuse consent to any care, treatment, service, or procedure that would affect a physical or mental condition.
• The right to select or discharge health care providers and institutions.
• The right to approve or disapprove diagnostic tests, surgical procedures, and medication programs.
• The right to approve, withhold or withdraw artificial nutrition and hydration and all other forms of health care, including cardiopulmonary resuscitation (CPR).
• The right to sign up for organ donation, authorize an autopsy, and direct disposition of remains.

Why should you appoint a health care proxy?

One of the main benefits of appointing a health care proxy is that it can give a person and their family peace of mind regarding medical care. Health care proxies remove or minimize much of the struggle and confusion that can happen during stressful times.

For example, family members may disagree on the type of medical treatment their loved one should receive. This can lead to arguments and issues that may escalate and require legal intervention to resolve. With a health care proxy, doctors will consult one individual to make these decisions instead of waiting on a group of people to agree on an option.

Another benefit of appointing a health care proxy is it can provide a level of control over health care decisions. For example, when an advance directive is created beforehand, the health care proxy must follow a person’s wishes that are defined in the document.

If a health care directive has not been created, the proxy will make decisions based on what they know about the wishes of the person they are representing.

Those wishes should be discussed with an appointed proxy when a person assigning the responsibility is mentally and physically capable. This allows them to still have a say in their medical care even when they are not capable at the time. This also eliminates much of the speculation and guesswork involved in medical care decisions.

How to choose the right person

Picking a health care proxy can be a difficult decision because it is a big responsibility to give to someone. It can be challenging to choose who is the best person to take on that responsibility.

Here are some things to consider when choosing a health care proxy:

• Age. It is essential to appoint someone 18 years or older so that they are legally able to make decisions for their charge.
• Familiarity. It is best to choose a proxy that is a close friend or family member who is trusted. This will make it easier to have difficult conversations and help them understand and honour any expressed wishes. For this reason, many people choose a family member such as a spouse or children. However, this is not required. A friend or a legal representative can be assigned as a proxy.
• Reliability. Choose someone that will be committed to their position as a health care proxy. The proxy must also be readily available to make decisions. For example, in the case of an accident, the proxy must be contacted as soon as possible as many decisions can be time-sensitive.
• Willingness to advocate. A health care agent should be willing to follow any expressed wishes, even if they may go against the wishes of other family members. For example, some religious doctrines prohibit the removal of life-saving interventions (e.g., ventilators). Still, if a person has conveyed that they do not want these services, an agent should be willing to honour and advocate that decision.
• Good communicator. A good health care agent will communicate with other family members with sensitivity and efficiency.
• Willingness to make difficult decisions. In some cases, agents may be required to make life or death decisions. Therefore, they must be willing to do what is best for a person even when under emotional distress.

Initiating the conversation

Many people don’t want to think about a situation where they cannot make their own decisions. Likewise, many family members do not want to think about when they must make decisions for their loved ones. However, this is not something that anyone can control or avoid. Moreover, some procedures may require forms to be completed beforehand (e.g., Do Not Resuscitate order). Therefore, it is important to have these kinds of conversations in advance.

Initiating a conversation can be difficult, but a place to start could be discussing another family member and what happened in their case. A strategy to do this might include discussing the death of a family member and inquiring about where or how they died, especially if their health care choices were a mitigating factor.

This can help start a conversation on where you would like to be in your final moments and what kind of care resources you’d like in place. If there are no examples in the family, discuss situations in the news. For example, start a discussion about a case of someone in an extended coma. (Here is one about a boy in a 10-month coma.)

This can be an opportunity to share views on the scenario and clarify what treatment would be preferred if a similar situation happened to you. Regardless of what choice you make, it is important to start these types of conversations before a situation arises and when it would be too late to express what you’d want.