Choosing a Healthcare Agent: Who Will Advocate On My Behalf?

Designating a healthcare agent – also called healthcare proxy or surrogate -- is a crucial part of advance care planning: your agent will be the person who is responsible for carrying out your healthcare wishes, advocating for your best interests, and making healthcare decisions on your behalf when you can no longer communicate for yourself. This role is a big responsibility and is inherently a position that requires trust. Therefore, the decision as to who you designate as your healthcare agent is an important one. The following considerations are a great way to start narrowing down your options and making the choice that is right for you.

1. Age: Most states require that a healthcare agent be at least 18 years of age (21 in Colorado), so you can’t choose anyone too young or they will be disqualified by state law. You may also want to consider what would happen if you were to outlive your healthcare agent. By choosing someone much older than you, you increase the likelihood that (a) you would need to move to your second or third choice, (b) the state would need to appoint someone on your behalf, and/or (c) locating the correct agent will take more time. 
   
2. Relationship: Some relationships will automatically exclude certain individuals from serving as your healthcare agent due to potential conflicts of interest…such as being your doctor or other healthcare professional. While many people choose their spouse, siblings, or adult children to serve as their healthcare agent, you are not required to choose a close relative. In fact, for some families the closeness of the relationship can make the tough decisions even tougher. It’s important to consider how your relationship with the potential healthcare agent may impact their ability to follow your wishes, no matter how challenging it may be.
   
3. Willingness: With that in mind, you will also want to have a conversation with the people you are considering about whether they would be willing to act as your healthcare agent. The role requires a lot of responsibility and may require that the agent make challenging decisions about your healthcare. It’s important for you to know that the person you pick feels comfortable serving as your advocate and will be able to set aside their own discomfort to act on your wishes if needed. 
   
4. Beliefs/Experiences: You will also want to consider whether the person you choose has strong opinions on end-of-life treatments due to personal beliefs or past experiences. Maybe they or a loved one have religious beliefs that makes it hard for them to consider certain medical treatments or burial options…it’s important for you to consider how your care may be affected.  
   
5. Personality: Serving as a healthcare agent can be a very stressful experience and requires a great deal of responsibility. When choosing someone to serve as your healthcare agent, it’s important to consider if they have the appropriate temperament and reliability to handle emotional and high stress situations. 
   
6. Proximity: Healthcare crises are often both time-sensitive and sudden, which makes it important that your agent can quickly be contacted. You may also want to consider how convenient it will be for your agent to travel to your location. Different time zones, travel time, and mobility are all things that can hinder a healthcare agent’s ability to be your best advocate. With current communication technology, it’s easier to have a healthcare agent who is not geographically close to you.  Choosing the right person is the most important thing.  It can be helpful if they are nearby, however, if they are accessible and easy to contact they can still serve as your agent even from far away.

Choosing a healthcare agent is an important step in completing your advance care plan. The people you choose to serve as advocate for your healthcare wishes will be responsible for making decisions for your care when you are no longer able to communicate for yourself. Alternatively, if you are ever asked to serve as a healthcare agent, you’ll understand the honor, privilege, and responsibility that comes with such a request. By taking the time to carefully consider who to designate (or whether to accept designation), you can ensure that you and your loved ones' wishes are followed, and enjoy the peace of mind that comes with planning ahead. 

If you or a loved one is in the process of making these decisions, there are a number of resources that can help you with advance care planning, conversation tips, and more at www.fivewishes.org.