Congratulations if you have designated a health care proxy. But don’t think that you are finished with the difficult work of end of life planning.

The Theoretical Versus The Actual

Most of us  will sign health care proxies while we are healthy.  We don’t have to give our proxies further instruction; absent specific directives from us, our proxies will make the decision they think we would make, were we able to do so.  Our proxies will serve us in good stead should we have an accident or sudden illness and be unable to make decisions.  But while we are healthy, it is difficult to project what we will want when seriously ill, and thus impossible to give more than theoretical directives.

When we face serious health issues, our thinking about what treatments we want are likely to become more focused, and may change significantly.  The person we name as our proxy is also likely to change over time based on proximity and changing relationships.  Thus our health care proxies and any advanced directives we elect to write to supplement our proxies are living documents that should change over time to reflect our circumstances,

The Proxy’s Role

The ability of your proxy to speak for you is only as good as the information you provide.  Sharing your thinking about your treatment decisions with your proxy is crucial to have an effective proxy. If your proxy is uncomfortable with your decisions or assuming the responsibility for making decisions, designate a new proxy.  Make sure to provide updated forms to your physician and to all who hold copies of your proxy.

Family Matters

One potential complication of the proxy system is that it requires us to choose only one person (and an alternate) to make choices for us. That choice can lead to hurt feelings among other family members who are not designated. Some people designate a non-family member as a proxy just to avoid choosing among loved ones. Some designate a non-family member because they think they will be able to make more objective decisions.

Occasionally, family members left out of the health care discussions challenge the choices made by the proxy. To avoid the hurt and the complications that arise when proxy decisions are challenged, consider discussing your decisions with your entire family.  In this way, everyone feels included in the discussion, and there are no surprises. Your family members do not have to agree with your choices, but they are less likely to challenge their validity if they know them in advance.

Wrapping It Up

Designating a health care proxy to make treatment decisions is an interactive and long-term process. It requires having discussions that frankly evaluate illness and acknowledge the possibility of death.  Most of us have no practice with these conversations. The hope is that by having these discussions, we can come to terms with illness and dying and have our own choices carried out.