1.  If you sign a different health care proxy at a later date,

2.  If you divorce or legally separate your spouse who you had named in your health care proxy as your agent,

3. If you notify your agent, doctor, or any other health care provider, either orally or in writing, that you are revoking your health care proxy,

4. And finally, if you do anything that will show that you want to revoke your proxy, such as telling other people that you are revoking it, ripping the proxy, etc.

Furthermore, if you have already executed a health care proxy in the past, you will not need to sign a new one.  However, it will be important to provide the health care institution with a copy of this proxy.  You can either provide them with a copy of your own, ask your attorney to send the hospital a copy, or ideally have a copy handy with your Primary Care Physician (PCP) so the hospital can contact your PCP and have them send it to the hospital.

For parents with kids in college here in Boston, this is especially important because your child is away at college and medical emergencies could arise and without a properly executed health care proxy for your child, parents can run into problems with doctors and hospitals.

If you have filled out a Do Not Resuscitate order and someone is able to show proof of this order to the ambulatory service or the hospital, then they will follow the wishes of the executor of the form and not use measures that will further your life if you are in critical condition.

Why would someone want this?  Many people who are in hospice care, end of life care, or who are terminally ill will choose to do this in order to not prolong the inevitable.  It is a choice that is personal to each individual person and you should speak with your family and loved ones about your choice so they understand it when the time comes.

Based on this language, you may name a nurse as your health care agent as well as a doctor as long as they do not work at a medical facility where you are, or may become, a patient.   However, if they are related to you by blood, marriage, or adoption they will be able to be your health care agent regardless.

This means that if you are divorced or even separated from your spouse, and you had named them as your health care agent, you will no longer have a health care agent.  You would need to execute a new health care agent that names someone else as your agent.

In order to avoid this type of problem, one should plan ahead and communicate with their doctor before they become ill.  You should tell your doctor of your proxy and wishes regarding medical treatment and determine ahead of time whether your doctor would be willing to comply with your wishes.

The person you designate as your spokesman or advocate doesn’t have to be a family member.  They only need to be someone you trust will keep your wishes met and speak for you.

Most people immediately think of their closest family member – whether that be your parents, your children or your spouse.  However, that might not be the best person to be making medical decisions for you in case of your incapacity.

Family members have the hardest time letting go.  One of the big responsibilities of a health care agent or proxy is to possibly stop life-sustaining medical care if you’re ever in a persistent vegetative state or coma.  This responsibility can be extremely hard for a close family member to carry out even if you have had a discussion about it with them in the past and/or you have it written down in a health care directive or living will.

Perhaps it would serve both you and your family better if instead of a close family member being your health care agent, you nominate a very close friend instead.  Not to say that some friends aren’t like family, but generally speaking, friends might be less emotionally affected with making a decision such as ending life-sustaining medical procedures than a very close family member would.

[NPR: Talk of the Nation Segment]

An excellent suggestion that the host made was that perhaps if you know you’re going to be prone to having alzheimer’s due to family history, maybe you could consider putting an instruction in your living will (or a Health Care Directive as we call it here in Massachusetts) that allows your health care proxy, nurse or caregiver to lie to you when you get to that sustained memory loss stage where it would do more harm than good to be truthful. In doing so, you not only taking the ethical debate out (since you said it was OK to do so in advance), but you also take the pressure off the caregiver by telling them, “Hey, it’s OK to lie to me. It’s better this way.”