You are in the waiting room of a hospital while a loved one - your parent, a partner, a spouse - is in surgery. The surgeon comes out to discuss the case with you and to ask for your permission to proceed, based on new information. If you agree with the doctor, the doctor may return to the surgery and all will go forward. If you disagree with the doctor's assessment, however, the doctor may then ask if you are the patient's health care agent. If you say no, not officially, then the fact is, you have no legal standing to direct the medical care.
It is at that moment that you realize how important it is to have a health care directive.
A health care directive is a legal document where the principal names an agent, often called the proxy, to make medical decisions for him. It is only activated if it is determined that the principal does not have the mental ability to make a health care decision for himself. This lack of capacity may be temporary, such as if he is under anesthesia, or it may be permanent condition, if the principal suffers from dementia.
The agent's duties may be fairly simple, such as signing off on a routine procedure. Or the agent may be called upon by a doctor or hospital to make very significant end-of-life decisions, involving such issues as whether or not to authorize artificial respiration, nutrition or hydration. As the agent may literally be making life or death decisions, it is vitally important for the agent to understand and respect the principal's views on these weighty topics.
If you are signing a health care directive, you should take the time to discuss your feelings about artificial hydration and nutrition with your agent, even if you have chosen someone who has known you for decades. Similarly, if you are named as an agent, ask the principal about these issues. You can use a Living Will as a guide. These difficult conversations will be remembered at a later date, and will serve as guide posts for the agent.
In some states, such as New York, a health care directive is a single page and simply names an agent. Often, a sentence is inserted that the agent is aware of the principal's "end of life wishes," but those wishes need not be in writing. In other states, the health care directive is many pages long and in addition to naming an agent, the directive contains "living will" language, spelling out how the principal wishes to proceed if it has been determined he "has no reasonable hope of recovery."
As with all legal documents, you need to know what your states requires for a health care directive to be valid. Many states have samples online and are easily accessible. Most hospitals require that one is filed before a patient has surgery.
By having a health care directive for yourself, or ensuring that your loved one has one in place, you can feel more confident that when that surgeon comes out and asks, "Are you my patient's Health Care Agent?" the answer will be an authoritative, "Yes," giving the agent the legal right to direct the medical care.