You’re awake most of the time when getting medical care. But the future is a funny thing. It’s not a given that you’ll be able to speak or even write your healthcare desires tomorrow or in 20 years. Advocating for yourself is difficult when you get incapacitated or can’t think and act clearly. If you’re in a coma or become unable to make decisions, someone else has to act on your behalf for many items like money, last wishes, and health. On the medical side of things, patients can avoid these confusing and traumatic situations by picking a healthcare proxy. Today’s episode isn’t legal advice at all, but I do want to offer some background on preparing for the worst situations where you need someone to know your healthcare preferences through and through.
If you can’t talk, write, or move, someone else has to carry out your healthcare wishes. This is where a healthcare agent or proxy comes in. Family members don’t always take the wheel for driving your care because every state has its own rules. A healthcare agent picked ahead of time in writing is entrusted to make your medical decisions if you’re down and out. Some help from a lawyer makes this setup possible. You’ve probably heard of a common document like a living will. Healthcare proxies are in that mix as well. A living will includes many nonmedical items, but also states healthcare wishes, including directions for what to do about life-prolonging or life-ending care. A healthcare proxy on the other hand involves a named person to make healthcare decisions in the event a patient can’t act for themselves. ‘Advanced directive’ is the term covering those instruments. A finished advanced directive usually has both the wishes laid out in a will and the persons named as health proxies. Patients can revoke them if changes need to be made for a proxy or specific medical desire. Bringing a written document to your doctors with healthcare wishes and designated agents leads the way for a clear medical direction. The earlier this is outlined, the better. If you get a will, healthcare proxy, or some combination, give that completed info to both your primary doctor and whoever’s managing your hospital care if necessary. The major situation to avoid is a patient becoming incapacitated and the physician asking the family what the patient would want, and then getting no answer.
So how many people use these legal tools for medical needs? To find out, the Health Affairs journal reviewed ~150 past studies of US adults with a completed living will, healthcare power of attorney, or both. Based on a sample of ~800K adults’ medical chart notes, the authors estimated that 37% of patients had completed advanced directives. The event behind this study and similar efforts was Medicare’s 2016 decision to reimburse physicians for advance care planning and counseling. If choosing a healthcare agent and having written-down last wishes matters so much, why aren’t that many people getting them set up? Not all advanced directives are thorough and some doctors may not be on board for them. It’s great that patients can make contingency plans in one place, but writing healthcare wishes on a napkin isn’t good enough. According to the American Bar Association, advanced directives usually require two adult witnesses. Each state has its own rules and in some cases these documents need to be notarized. Having a lawyer whip up a living will can be $500-$750+ depending on the state. That’s a significant expense for many families. Not everyone needs healthcare proxies or medical wishes—healthy patients don’t usually plan for their demise. To adjust for these realities and affective forecast errors, the study authors plotted how many adults within major disease groups completed advanced directives. Patients with issues like heart disease, cancer, and neurological problems tend to exceed the national share of adults with finished advanced directives. That figure and other sources in this pod will be on my post at rushinagalla.substack.com. Given these facts, it’s possible to think of living wills and healthcare agents like insurance. You may not use it, but if you need to, you’ll be happy that it’s there. Having a healthcare proxy knowing your clear medical desires also saves providers time in executing treatment, which saves money.
Let’s assume that you know exactly what should be done for medical care if you’re incapacitated. You’ll still need an agent that everyone can trust. The best times for thinking about getting a proxy would be as a patient ages, when a major life event happens, or if a serious illness gets diagnosed. Healthcare proxies are expected to speak for the patient’s wishes, have access to said patient’s complete medical record, and collaborate with various providers. Most hospitals and clinics follow HIPAA guidelines for privacy—upon choosing a proxy, you’ll have to add his or her contact info to your health record. Family, friends, and peers of a similar faith are candidates to start with. Regardless of who you choose, make sure that person is decisive. No other character traits for a proxy matter nearly as much as quick-thinking and knowing your wishes by heart.
If you remember nothing else from today’s episode, know that a proxy is linked to a person, and a will is linked to wishes. Every patient has different needs and situations. It’s a personal choice to build contingency healthcare plans, but more patients should be informed of all the pros and cons to make better decisions. Having someone by your side when life doesn’t go smoothly is a plus, even if that person isn’t legally representing you. Another useful kind of agent to have at your side is a health insurance broker. American health plans, among many other parts of our medical system, are complicated. I’ve spent a bit of time walking you through health plan concepts in past episodes. That basic knowledge is still crucial. In the next episode, you’ll know how an insurance broker matching up with your aims goes a long way to finding the best coverage possible. Stay tuned and subscribe to Friendly Neighborhood Patient for all the goods on ground-level healthcare topics. I’ll catch you at the next episode.
