How can I appoint a health care agent?
All competent adults can appoint a health care agent by signing a form
called a Health Care Proxy. You do not need a
lawyer, just two adult witnesses.
When would my health care agent begin to make treatment decisions for me?
Your health care agent would begin to make treatment decisions after doctors
decide that you are not able to make health care decisions. As long as
you are able to make treatment decisions for yourself, you will have the right
to do so.
What decisions can my health care agent make?
Unless you limit your health care agent's authority, your agent will be able
to make any treatment decision that you could have made if you were able to
decide for yourself. Your agent can agree that you should receive
treatment, choose among different treatments, and decide what treatments should
not be provided, in accord with your wishes and interests. If your health
care agent is not aware of your wishes about artificial nutrition and hydration
(nourishment and water provided by feeding tubes), he or she will not be able
to make decisions about these measures. Artificial nutrition and
hydration are used in many circumstances, and are often used to continue the
life of patients who are in a permanent coma.
How will my health care agent make decisions?
You can write instruction on the proxy form. Your agent must follow
your oral and written instructions, as well as your moral and religious
beliefs. If your agent does not know your wishes or beliefs, your agent
is legally required to act in your best interest.
Who will pay attention to my agent?
All hospitals, doctors and other health care facilities are legally required
to obey decisions by your agent. If a hospital objects to some treatment
options (such as removing a certain treatment) they must tell you or your agent
in advance.
What if my health care agent is not available when decisions must be
made?
You can appoint an alternate agent to decide for you if your health care
agent is not available or able to act when decisions must be made.
Otherwise, health care providers will make treatment decisions for you that
follow instructions you gave while you were still able to do so. Any
instructions that you write on your Health Care Proxy form will guide health
care providers under these circumstances.
What if I change my mind?
It is easy to cancel the proxy, to change the person you have chosen as your
health care agent, or to change any treatment instructions you have written on
your Health Care Proxy form or wallet card. Just fill out a new form or
card (cards are available free of charge by calling Crouse
Hospital’s
Communications Department at 315/470-7701 or by E-Mail
). In
addition, you can require that the Health Care Proxy expire on a certain date
or if certain events occur. Otherwise, the Health Care Proxy will be
valid indefinitely. If you choose your spouse as your health care agent
and you get divorced or legally separated, the proxy is automatically
cancelled.
Can my health care agent be legally liable for decisions made on my
behalf?
No. Your health care agent will not be liable for treatment decisions
made in good faith on your behalf. Also, he or she cannot be held liable
for costs of your care, just because he or she is your agent.
Is a health care proxy the same as a living will?
No. A living will is a document that provides specific instructions
about health care treatment. It is generally used to declare wishes to
refuse life-sustaining treatment under certain circumstances. In
contrast, the health care proxy allows you to choose someone you trust to make
treatment decisions on your behalf. Unlike a living will, a health care
proxy does not require that you know in advance all the decisions that may
arise. Instead, your health care agent can interpret your wishes as
medical circumstances change and can make decisions you could not have known
would have to be made. The health care proxy is just as useful for
decisions to receive treatment as it is for decisions to stop treatment.
If you complete a Health Care Proxy form, but also have a living will, the
living will provides instructions for your health care agent, and will guide
his or her decisions.
Where should I keep the proxy form after it is signed?
Give a copy to your agent, your doctor and any other family members or close
friends you want. You can also keep a copy in your wallet or purse, or
with other important papers. Crouse
Hospital has developed a
wallet-size version of the Health Care Proxy that enables you to carry this
with you at all times. Cards are
available free of charge by calling Crouse
Hospital’s
Communications Department at 315/470-7701 or by sending an E-Mail
.
Does completing the wallet-size version mean that I don't have to fill
out a full-size Health Care Proxy form?
The wallet-size version of the Health Care Proxy form is an abbreviated
version of the full-size Health Care Proxy form.
This card is intended to be carried with you; you should still complete a
full-size version of the proxy form and give copies to your agent, your doctor,
your attorney, and any other family members or close friends you choose.
APPOINTING A HEALTH CARE AGENT IS A SERIOUS DECISION. MAKE SURE
YOU TALK ABOUT IT WITH YOUR FAMILY, CLOSE FRIENDS, AND YOUR DOCTOR.
DO IT IN ADVANCE, NOT JUST WHEN YOU ARE PLANNING TO ENTER THE
HOSPITAL.
FILLING OUT A HEALTH CARE PROXY IS VOLUNTARY, NO ONE CAN REQUIRE YOU
TO DO SO.
About the Health Care Proxy
This is an important legal form. A printable version can be accessed by
clicking here.
Crouse
Hospital
also has wallet-sized versions of the card available free of charge by
calling
315/470-7701 or by E-Mail . Before signing this form, you should understand the
following facts:
- This forms gives the person you choose as your
agent the authority to make all health care decisions for you, except
to the extent you say otherwise in this form, "health care" means any
treatment, service or procedure to diagnose or treat your physical or
mental condition.
- Unless you say otherwise, your agent will be
allowed to make all health care decisions for you, including decisions
to remove or provide life-sustaining treatment.
- Unless your agent knows your wishes about
artificial nutrition and hydration (nourishment and water provided by
a feeding tube), he or she will not be allowed to refuse or consent to
those measures for you.
- Your agent will start making
decisions for you when doctors decide that you are not able to make health
care decisions for yourself.
You may write on this form any information about treatment that you do not
desire and/or those treatments that you want to make sure you receive.
Your agent must follow your instructions (oral and written) when making
decisions for you.
If you want to give your agent written instruction, do so right on the
form. For example, you could say:
If I become terminally ill, I do/don't want to receive the following
treatments...
If I am in a coma or unconscious, with no hope of recovery, then I
do/don't want...
If I have brain damage or a brain disease that makes me unable to
recognize people or speak and there is no hope that my condition will improve,
I do/don't want...
I have discussed with my agent my wishes about _______ and I want my
agent to make all decisions about these measures.
Examples of medical treatments about which you may wish to give your agent
special instructions are listed below. This is not a complete list
of the treatments about which you may leave instructions.
- artificial respiration
- artificial nutrition and hydration (nutrition and
water provided by feeding tube)
- cardiopulmonary resuscitation (CPR)
- antipsychotic medication
- electric shock therapy
- antibiotics
- psychosurgery
- dialysis
- transplantation
- blood transfusions
Talk about choosing an agent with your family and/or close friends.
You should discuss this form with a doctor or another health care professional,
such as a nurse or social worker, before you sign it to make sure that you
understand the types of decisions that may be made for you. You may also
wish to give your doctor a signed copy. You do not need a lawyer to
fill out this form.
You can choose any adult (over 18), including a family member, or close
friend, to be your agent. If you select a doctor as your agent, he or she
may have to choose between acting as your agent or as your attending doctor. A
physician cannot do both at the same time. Also, if you are a patient or
resident of a hospital, nursing home or mental hygiene facility, there are
special restrictions about naming someone who works for that facility as your
agent. You should ask staff at the facility to explain those
restrictions.
You should tell the person you choose that he or she will be your health
care agent. You should discuss your health care wishes and this form with your agent.
Be sure to give him or her a signed copy. You agent cannot be sued for
health care decisions made in good faith.
Even after you have signed this form, you have the right to make health care
decisions for yourself as long as you are able to do so, and treatment cannot
be given to you or stopped if you object. You can cancel the control
given to your agent by telling him or her or your health care provider verbally
or in writing.
