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Later Life Planning

How to plan ahead for common concerns at the end of life

What Does a Health Care Agent Do for Us?

Once you have some idea of what you want, it is a very good idea to choose one or more health care agent(s), or a health care proxy, or a substitute decision-maker (these are different names for the same role). Someone who can speak to a health care team about what you want, if you aren't able to speak for yourself.

Why Would Someone Need a Health Care Agent?

Reason #1 - Health care professionals are probably not the best people to make those decisions for you. They're probably the best to give you or your health care agent explanations and advice, but they won't know your values and what's important to you unless you or your health care agent can tell them.

Reason #2 - In times of crisis, health care professionals are trained to do the best they can to enable you to leave the ER or Intensive Care. But that might mean more aggressive treatment than you want, or cause more problems in the future. They may take heroic measures that you would prefer to avoid (if paramedics are called in, for example, they may refuse Do Not Resuscitate orders); also take a look at the section for Medical Decisions on our webpage for Options at the End of Life for other possible matters of concern.

If you can't tell them what you want, who will? 

Reason #3 - in California, the responsibility of making decisions in a medical emergency, if you can't do it for yourself, does not automatically go to next of kin.

Please note that in CA  - as opposed to other states - your current spouse's wishes do not automatically take priority over other family members' (or over ex-spouses' wishes, if they are present and included in discussions).  Instead, your health care team has to try to balance the wishes of all family members present. That potential for conflict makes it even more important to decide upon a health care agent.

Reason #4 - In a medical emergency, it is much easier for the health care team to communicate with a spokesperson. if a patient's status changes fast, there may not be time to bring everyone together to make a decision, even if that is the family's usual way of doing things. For this reason, it is also a good idea to have a backup health care agent. (Like any good understudy, the backup agent also needs to have the same information as the first choice agent.)

Choosing a Health Care Agent

To see Spanish subtitles in the video above from the Conversation Project, click on the smal gear icon for Settings, select "subtitles" , and choose "Default Spanish".

These links have good advice on how to choose your health care agent:

You can choose your spouse as your health care agent, of course, or you can choose someone else if you feel that it would be hard for your spouse to make unemotional decisions in such a difficult time.

When is the best time to choose a health care agent?

Ideally, before it's too late. But we can't always know when that is, so make it the next step after you have thought through your preferences for your end of life. It's especially important to do this - and to review your advance care plans, and your choice of health care agent - after major life events like:

  • coming of age, especially if you're moving away (even if it's just for college - privacy laws mean that your parents may not be automatically notified if you have a medical emergency);
  • getting married, divorced, or losing a spouse;
  • having a child;
  • being diagnosed with a serious disease.

Someone you know has just asked if you would be their health care agent - now what?

First, talk with them and read up on the job of a health care agent, to decide if you wish to take on this responsibility. If you decide yes, these resources can help you prepare:

The resources below link to helpful information for health care agents,  in several different languages besides English. While the Australian regulations and organizations it mentions may not apply to the U.S., the personal considerations are universal. 

The text on this page is copyright PlaneTree Health Library, licensed under Creative Commons CC BY-NC-SA 4.0. Linked contents are the responsibility of their creators or copyright holders.