How to Choose a Good Health Care Proxy (Agent)

A health care agent (sometimes called a health care proxy) is someone you choose to make medical decisions for you if you can no longer communicate your own wishes for care. Think of this person as your advocate in a medical setting. This is one of the most critical decisions you will make about for your future, so it's very important to give some thought about choosing the right person for this role. 

As a point of clarification, there are several terms used to describe this role:  a health care power of attorney, health care proxy (this is also the name of the document you complete), health care representative, and health care attorney-in-fact.

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What kinds of decisions would a health care agent make for me?

Once a health care proxy goes into effect,  a health care agent can make any decision relating to your medical care. They work directly with your care team to make informed decisions about the kind of care you should receive (or not receive) based on any wishes you have expressed to them in person or in a living will. Here are some common things a health care agent may make decisions about:

• Approval of tests, surgeries, medications, and other treatments
• The setting in which you receive care: hospitals, hospice, nursing homes, assisted living, etc
• The decision to pursue or decline life-sustaining interventions like dialysis, breathing machines, CPR, or artificial nutrition/hydration
• The release of your medical records to a third party

What makes a good health care agent?

Many people look to family members, spouses, domestic partners, and close friends to fill this role. However, your decision should be based off how well the individual knows you, and how likely they would be to respect your wishes.

There are common traits that make some people better agents than others. As you read the following traits, make a list of people in your life who fit these characteristics as a first step toward making a decision.

Traits of a good health care agent:

• Listens to me; asks questions about my life
• Can agree to disagree with me about tough topics, non-judgmental 
• Has been reliable, someone I can regularly depend on for important matters
• Makes time for me
• Knows what is important to me in life, or open to discussing such topics with me
• Mentally and emotionally resilient
• May have already been a health care agent for someone else
• Good reasoning and decision-making skills, able to balance matters of the heart and mind
• I could trust this person with my life

Traits to avoid:

• Not a good listener
• Can't agree to disagree
• Tells me what I should think, rather than asks my opinion
• Does not seem to consider my feelings when making important decisions 
• Difficult to get in touch with
• Uncomfortable or unwilling to talk about illness or death
• "Shuts down" when serious decisions need to be made
• Has a black-and-white view of the world

Choosing a health care agent

Those traits may have brought some clarity to who may be a good health care agent for you. Maybe more than one person came to mind for this role.

You can choose a primary and alternate health care agents. We strongly encourage people to consider naming an alternate as a safety net if your primary agent passes before you or is otherwise unavailable to fulfill the responsibilities of the  role at a later date. Most states will allow you to specify how you want the alternate(s) to be included in the decision-making process -- either as a backup, should the primary agent be unavailable, or to support and make joint decisions with the primary agent. 

If you are considering someone significantly older than you to fill this role, it's important to recognize the possibility they may pass before you. In this case, it's a good idea to designate an alternate health care agent who can perform these duties if the primary health care agent is not able to do so. 

Choosing an agent does not have to be a final decision. As life and relationships change, you can always designate a new health care agent by completing a new Health Care Proxy form. Just be sure to update everyone affected by such changes. 

What if I can't think of anyone to be my health care agent?

If looking to your immediate circle of family and friends does not yield a good option, consider other people in your life like a trusted neighbor, spiritual leader, colleague, or extended family member.  

Ask them first!

Before you complete a Health Care Proxy form to designate your health care agent(s), make sure you ask your agent(s)-to-be if they are willing to take on this responsibility. Not everyone will be comfortable with this, so it is important to ask before you make it official on the form. Set aside some time for a phone call or in-person chat to make sure you have time to discuss any concerns they may have.

Here are some questions you can ask them:

• Are you comfortable making decisions for my medical care if I can't speak for myself?
• Will you respect my wishes for care, even if you disagree with them?
• Are you comfortable advocating for me in a challenging medical environment?
• Would you be by side in an emergency? Are you able to travel to be there for me (if they don't live close to you)?
• Do you have other responsibilities that could interfere with your ability to do this job well?

Complete a health care proxy form

You can complete this step by creating a free Cake account and navigating to the Health Care Proxy section of your account.  If you prefer to print your state's form, you can find it on our Advance Directives by US State resource page.

Have a follow-up conversation with your health care agent(s)

One final, important step is to make sure your newly-appointed health care agent receives a copy of the health care proxy document and knows your wishes for care. 

Consider creating a free Cake account and completing the healthcare card decks to get a better sense of your care preferences before having this conversation with your agent. These card decks will walk you through a number of healthcare decisions. Your answers are used to create a Cake Advance Care Plan that you can discuss and share with your health care agent(s). If you have already completed the healthcare section on Cake, you can use the Cake Advance Care Plan document that was generated for you to aid in your discussion.  

Here are some things to cover in your conversation:

• Tell them what is important to you in life. What brings you joy and makes life worth living to you?
• What worries do you have about the future and your medical care?
• What kinds of life-sustaining medical care would you want to receive in an emergency in your current state of health? If you were seriously ill, or frail?
• If you were terminally ill, would you want to receive care at home if possible?

Make sure that your agent(s) understands your preferences. Ask them to repeat your preferences back to you to make sure they understand. 

What if I change my mind down the road?

You can always change your mind and appoint a new health care agent. Although exact requirements differ by state, you will generally need to fill out a new health care proxy form, dispose of old copies, and make sure your doctor, lawyer, and others have an updated version. You should also communicate this change verbally or in writing to your family and the agent(s) from whom you are revoking power. 

If you are using Cake to complete your end-of-life planning documents, you can easily update your Health Care Proxy document and notify the important people in your life of these changes.