What Is the Role of a Health Care Proxy?

A health care proxy makes medical decisions for a person who is very ill, unconscious or mentally incapacitated. According to LawHelp.org, a proxy or surrogate is required to act in good faith and follow an individual’s wishes when those wishes are known. 

Some decisions a health care surrogate may make on a patient’s behalf include:

• Whether to admit or discharge them from a hospital or nursing home
• Which treatments or medicines they do or do not receive
• Electing care and support options such as hospice or palliative care
• Whether to institute or discontinue life support 
• Whether to donate organs or tissues after death

A health care proxy also has the difficult job of advocating for the patient with health care providers. This can be especially challenging in situations when medical decisions are not clear-cut. For example, a patient who has a life-limiting illness such as cancer may be doing well clinically when a sudden infection causes them to become gravely ill. At that juncture, the health care team might think that a short stay in the ICU on a ventilator would allow the person to return home and enjoy a good quality of life for quite some time. But family members might feel strongly that being on a ventilator is not what the patient would want. Further, it’s unlikely that an advance directive or even a POLST would address this exact scenario. So the surrogate would be charged with making the decision they believe the patient would make themselves. 

Patients, or, more often, their surrogates, have a number of options when these types of disagreements occur. According to the National Institute on Aging, these include requesting a consultation with the hospital’s palliative care team, who can help guide the discussion about long- and short-term prognoses and goals of care. Family members may also request a consultation with the hospital’s ethics committee, a group of health care professionals who are not involved in the patient’s care and can help resolve conflicts while ensuring that the patient’s rights are respected and their needs are met. If the surrogate is having difficulty getting these consultations or needs additional help, they can contact a hospital representative such as an ombudsman or administrator. 

Sources“Making Decisions for Someone at the End of Life”. National Institute on Aging. https://www.nia.nih.gov/health/end-life/making-decisions-someone-end-life