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Why Everyone Needs a Healthcare Proxy

What it means (and doesn’t mean) for your advanced care decisions.

Photo credit: Getty Images

Who would you trust to make healthcare decisions on your behalf if you weren't able to?

Assigning a healthcare proxy ensures that the person you'd want to be there to advocate for your wishes has the power to do so. And as Dr. Maria Carney, chief for the Division of Geriatrics and Palliative Medicine at Northwell Health explains, it’s something you should think about having in place—even if you're in perfect health. "A healthcare proxy isn't just for end of life issues," she says. "It's having someone who knows how you would want to live, to get you through certain events—for example, agreeing on a hospital discharge plan, including determining if you go home or which rehabilitation facility to send you to after an accident."

Here's what you need to know about the role of a healthcare proxy—what it involves, how to appoint one, and ways to communicate your healthcare wishes.

Who is your healthcare proxy?

If you haven't appointed a healthcare proxy, New York state has a default system in place for who to reach out to in the event you're unable to make informed medical decisions as determined by the designated clinicians. "The legal system states it first goes to your legal guardian appointed by a court of law," Dr. Carney explains. "If you are not in a situation to have a designated legal guardian, the next point of contact would be your spouse. If you do not have a spouse or domestic partner, it then goes to your adult child (the law doesn't designate which one, so it would be whichever one is available), then a parent, then a sibling, and finally a close friend."

Adam Kahn, an attorney and senior fellow for the Gitenstein Institute for Health Care and Policy at Maurice A. Deane School of Law, says people shouldn’t be nervous that someone is going to override their ability to make decisions. “This is a non-issue because these ‘mechanisms’ for making medical decisions are only applicable when the patient has been determined to lack the capacity to do so on their own,” he says. Basically, the decisions are yours unless you’re not able to make them. Hence the need for a proxy who understands your wishes.

Who should be your healthcare proxy?

Choosing a healthcare proxy is a personal decision—one that's not always as straightforward as you might think. Kahn, who works with The Chat Project, a partnership between the Gitenstein Institute and Northwell Health that is dedicated to educating the public on advanced care planning, suggests considering a few factors when determining who to choose. "You should consider who you would trust to know your medical history, to have access to your medical information, and to have conversations with your doctor." Availability is something else to take into account. "For example, if you have more than one child, you can only pick one to be your healthcare proxy—so if one of them is always traveling around the world, maybe that’s not the best one to choose," he says. "Ultimately, trust is the most important factor. You'll want someone who's going to make decisions based on what youwant—even when it might not be what they're most comfortable with."

“The best time for these conversations is not at the time of crisis, because that’s when emotions run high.”
Adam Kahn, attorney

The difference between a healthcare proxy and a living will

In the talks Kahn gives with The Chat Project, one of the most frequently asked questions is the difference between a living will and a healthcare proxy. A living will communicates, on paper, your wishes about whether you would want interventions like artificial hydration or nutrition. "Having a healthcare proxy is naming someone to make the medical decisions when you can't, whereas the living will is basically guidance to the person you choose to make your decisions and evidence of your wishes," Kahn explains. You can state those wishes in your healthcare proxy form as well, which would then be carried out by the proxy you assign to make the decision.

Appointing a healthcare proxy

Once you've decided who you'd like to be your healthcare proxy, you'll need to fill out a form from the New York State Department of Health, which can be accessed here. "You don't need a lawyer—you just need witnesses," Dr. Carney explains. There's no notice of approval you'll receive after you send it in, so be sure to make copies to have on hand. "Give one copy to your proxy, make copies for yourself, and give copies to other family members," she says. "You may want to give one to your doctor, and have multiple copies on hand so that you always know where they are." The paperwork never expires, but if you do decide to update your healthcare proxy point of contact, you'll need to fill out another form.

Talking with your healthcare proxy

In his work with The Chat Project, Kahn advises groups and individuals on how to broach this tough topic, including when and where to have the discussion. "Choose an occasion where your family and loved ones are together—maybe a quiet moment at a holiday celebration or summer barbecue—so that you're able to communicate your wishes to everyone who might be involved when a decision must be made," he says. “If you think your family members will try to deter you from having the conversation, make sure you establish why you feel it's important to talk about this now. Communication is the key.”

Kahn suggests saying something like, “I want you to know these things because when you are making decisions for me later, I don’t want you to feel like you have to make them on your own. I want you to feel like you know what I want, because we talked about it."

Another helpful way to frame the conversation? Use relevant examples from pop culture as a jumping off point. "Maybe something comes up in a TV show where somebody has to make a medical decision for somebody else," Kahn says. "That might be an opportunity to turn to somebody and say, 'If I was in this position, this is what I would want.’"

Kahn's biggest tip? Have the conversation sooner rather than later. “The best time for these conversations is not at the time of crisis, because that’s when emotions run high,” he says. “People aren’t thinking as clearly, and there are other considerations going on.”

Visit TheChatProject.com for more resources on how to talk about your healthcare wishes with your loved ones.

Next Steps and Useful Resources

  • Start a healthcare proxy conversation with your doctor. Don't have one? Meet with any of our Northwell Health physicians using our Find a Doctor locator today.
Published June 12th, 2018