How to Choose the Best Healthcare Proxy

Choosing an agent or healthcare proxy is one of the most crucial parts of completing Power of Attorney paperwork. Yet, the decision doesn’t often get enough attention. It’s too easy to simply choose the person you feel closest to, like a spouse or an adult child, without realizing that they’re not necessarily the best choice. 

Today, we’re digging into things you should think about when choosing the best healthcare proxy for your needs. You should also consider adding a backup agent in the paperwork, in case the initial one cannot do it for any reason.

The Role of Your Agent

When you lose decision-making capacity, your agent starts making decisions for you. This could include choosing whether you receive specific medications, when you enter hospice, and which procedures to allow.

Those are big decisions that have dramatic impacts.

Your agent doesn’t simply make these decisions based on their own wishes. Instead, their choices are governed by the law.

In Arizona, for example, the agent must first follow your Living Will. If there isn’t a Living Will or it doesn’t cover the situation, the agent should use their knowledge of your values instead. If even that isn’t enough, they must make a good-faith decision about what is in your best interests.

Other states follow similar approaches, but the exact laws and their implications can differ somewhat.

Beyond this, your agent should act in your best interests, keep good records, and ensure that there are no conflicts of interest.

Why You Should Consider Your Agent Carefully

They’re Interpreting Your Wishes

Even with these laws, your agent will have to interpret your Living Will. They may also be making some decisions that weren’t covered in the document. After all, it’s impossible to think of every possible situation when doing your advance planning.

This means you’ll need someone you trust in the role – someone who can make good decisions under pressure.

They Could Break Trust

Speaking of trust, some agents do abuse their position. There are even cases of agents restricting family members from visiting their loved one or agents who have misused funds. While such issues aren’t common, they’re another factor when you’re looking for the best healthcare proxy.

Changing the Agent Isn’t Always Easy

While you have capacity, you can easily remove one agent from your PoA and add another. That’s no problem.

Things get trickier when you lose decision-making capacity. At this point, the information in your PoA stands and your agent can’t be easily changed.

To remove the agent, family members would need to get the courts involved and prove that the agent is abusing their position. Doing so can be time-consuming and difficult. Some families even find themselves stuck with a problematic agent, as they can’t prove any wrongdoing.  

What Impacts the Agent’s Success?

How Well They Know You

Not surprisingly, you want your PoA agent to know you well – as they’re making decisions on your behalf.

This means they should know your wishes and the values underlying them.

Your Living Will should help them with this process, but it’s unlikely to cover every circumstance and decision. The better the agent understands you, the easier their job will be.

This is a key reason many people choose spouses or adult children as their agents. Still… it’s worth stopping and thinking about this one. How well does the person you’re considering really know you? Do you have meaningful conversations with them? Do they know what matters to you?

If you’re setting up this paperwork in advance, you may have time to talk with your potential agent. This will give you the chance to bring them up to speed. If time is short, you may need to focus on people who already know you well.

Their Relationship With You

It’s also worth thinking about the nature of the relationship – especially with adult children and spouses.

Are there any underlying issues to consider? Do you generally get along well? Are fights or miscommunication common?

If you often don’t see eye-to-eye, the individual mightn’t be the best choice as an agent. 

Their Organizational Skills

Healthcare proxies often need to deal with a considerable amount of paperwork, meetings with doctors, and conversations. There’s a lot of information and appointments to keep track of, so you want someone who can organize things well.

This becomes especially important for people with complex medical conditions. Sometimes, it takes a lot just to understand pain management systems or the different medication timings. Then there are all the processes involved in switching from one type of care facility to another.

Someone with organizational skills has a much better chance of navigating the system and getting the desired results.

Can They Advocate For You?

Being a proxy isn’t a passive role. Proxies will often need to advocate repeatedly to make sure your wishes are met.

This happens because the healthcare system has its own momentum and a strong focus on extending life, even when doing so diminishes quality of life. Your proxy needs to be able to talk to healthcare staff effectively, understand the different options, and hold their position well.

It also helps if your proxy has some understanding of medical language. This isn’t essential, as they can learn, but any initial understanding is still helpful.

Think about how your potential agent handles conflict and difficult situations. Are they able to stand up for what they need? Can they negotiate without causing a fight? Such skills will help them in their role.

Their Resilience and Capacity

How well does your potential agent respond to challenges? Can they juggle multiple challenges at once for a decent amount of time?

We ask because being a proxy can be intense. Some people do well in such roles, pulling on hidden reserves of strength and resilience to withstand any challenge. Others risk collapsing into themselves and being unable to continue.

Your potential agent’s history will give you some idea of how well they do in a crisis.

As part of this, think about any vulnerabilities your agent may have. For example, someone with PTSD or depression may struggle to balance the practical and emotional challenges of being your agent, especially as they are also dealing with aspects of grief. 

Their Proximity

Everything will go much more smoothly if your agent lives near you (or is willing to temporarily move for the duration). People who live far away will struggle with their roles and responsibilities, especially when decisions must be made quickly.

Their Lives

The various tasks of a healthcare proxy take plenty of time and energy, so your agent needs enough of both. This is even more significant if the agent is responsible for multiple roles, like being named in a financial PoA and a healthcare PoA.

Because of this, it’s worth thinking a bit about the life your potential agent leads. Do they have young kids and a full-time job? If so, they might struggle to split their attention as needed. 

What You Can Do

Evaluate, But Be Realistic

So, there’s a variety of things to consider when choosing your agent. You might begin by considering potential agents and how well they might do in the areas we’ve discussed. Notably:

• Do they know you well?
• Is the relationship healthy?
• Are they organized?
• Will they be a good advocate?
• Do they cope well with challenges?
• Do they live near you?
• Do they have enough time and energy to be an agent?

There probably won’t be a perfect candidate. That’s fine. The goal is simply to find people likely to be good agents. After all, there’s no way to predict how things will play out in practice. Some people may look like poor agents on paper but actually do the role well (and vice versa).

With that in mind – try to be realistic with your evaluations. Don’t stress too much about finding the ‘perfect’ candidate. If nothing else, the process of evaluating should help you avoid potential agents who would be an extremely poor fit.

Have Honest Conversations with Family Members

Family members sometimes take on the agent role out of a sense of duty, without understanding what’s expected of them.

It may help to have conversations with them about the role, including what it involves and how it often requires considerable time and emotional energy.

You might stress that you only want them to be your agent if they feel they can do the job well. Otherwise, they could easily be causing more harm than good. Relaying this perspective can help family members to give an honest answer, instead of saying yes simply because they think they should.

For example, a caregiving daughter might initially seem like the best choice for a PoA agent, especially as it’s clear that she can handle stress well. However, she may already be overloaded and near burnout, without adding the PoA role. Likewise, a competent adult son could be a poor choice if he has a busy life and different values to yours.

Update Your Paperwork Regularly

Finally, it’s important to update your paperwork regularly, as life never stands still.

Ideally, you should be updating documents any time there’s a major change in your life, such as a change in relationship status, a significant diagnosis, or the death of a loved one.

Also consider an update if there are notable changes for your named agent. For example, if your adult daughter gets married and now has a newborn, she may no longer be able to effectively act as your agent.

Final Thoughts

Choosing an agent doesn’t need to be stressful or incredibly difficult. But, it is important to consider the points we’ve discussed, including how well the potential agent knows you, their capacity and resilience, and their ability to advocate.

Weighing up these areas should help you choose an agent who can support you well – no matter what happens next.