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.”

The article recounts the story of Bob and Dorothy who met each other at an assisted living community. Just as the title says, they fell in love and started to have sexual relations. Bob’s son, who was appointed Bob’s guardian (either through a court guardianship procedure or health care proxy), decided to put a stop to the relationship after walking in on his father and his new girlfriend having sex at the assisted living center.

If you read through the article, an interesting concept of a Sexual Power of Attorney comes up. Dorothy’s daughter, who is an attorney, comments (maybe facetiously) that a Sexual Power of Attorney might allow the elderly to control their own sexual experiences when they reach a point of dementia. I’m not sure how this sort of power of attorney would work and how you would designate a person to oversee your sexual future. The concept however, is very interesting.

As I have said in previous posts, you should always designate someone to be your attorney-in-fact or proxy who you would trust your life with. You need to trust this person not only to keep you alive when you’re in a vegetative state or to pay your health care bills when you’re incapacitated, but you also need to know that this person’s values and beliefs are in line with your own. You need to be able to trust this person to make the same decisions you would make, or at least follow your intent and look out for your best interest. I’m not sure Bob’s son in the article was looking out for his father’s best interest. It seemed he was either trying to safe-guard his inheritance or to keep his father alive but lifeless to satisfy his own need to keep his father around. Sometimes immediate family members are not the best people to designate for such important roles.

Everyone over the age of 18 needs a health care proxy because we can all become incapacitated at a moments notice. People do not know when they might become incapacitated or expect it but we can all plan for it. The reason why children (people under the age of 18) don’t require a health care proxy is because their parents have the automatic authority to act on their behalf and make decisions for them. As adults, we’re on our own.

What does incapacity mean? Incapacity could be any event where you no longer can communicate your desires. This could be a vegetative state, persistent or otherwise, or a coma. The health care proxy’s job is to tell the doctors what you would want, if you were able to communicate. Ideally, a proxy should follow what you had laid out in your health care directive. A health care directive is simply a document that lists what you would want or not want if you were ever to become incapacitated. For example, many people do not want to be kept in a persistent vegetative state and therefore their directive would state that and give the proxy the authority to disconnect life support. Without such a document and proxy, doctors and hospitals are very reluctant, without a court order, to “pull the plug”.

A prime example of an unexpected real-life event is the Terri Shiavo case back in 2005. Terri was a normal woman who suddenly collapsed into a persistent vegetative state in 1990. When all treatment and remedies had been exhausted, her husband decided that it would be better if Terri was no longer placed on life support. However, Terri’s parents did not feel the same way and a costly and emotionally wrought legal battle ensued. We have no way to know what Terri would have wanted if she had known what would happen to her back in 1990. However, if Terri had had a health care directive stating that if she were ever to be in a vegetative state she would like to be removed from all life sustaining equipment and named her husband as her health care proxy, the costly law suit would never had taken place. Terri’s husband would automatically be allowed to make her health care decisions for her, even if it meant ending her life.

Terri Shiavo’s case is just one example of how useful a health care proxy could be and how important one is when the unthinkable happens to us.