Why name a Medical Proxy?
THE IMPORTANCE OF A MEDICAL PROXY
If you become critically ill, and unable to communicate your wishes, the doctor or medical healthcare givers treating you will consult with your Medical Proxy concerning the terms of your directive. This gives you another layer of protection in ensuring your wishes are respected.
Although you may have written an Advance Directive, a situation may arise where your medical condition at the time is not one that is addressed in your directive. Your Medical Proxy would then be able to make a decision on your behalf, based on his/her understanding of what you would decide for yourself, if you were able to do so.
Should you suffer a mental impairment, are unable to communicate your wishes, and your lack of capacity has been confirmed, your Medical Proxy has the authority to make arrangements for your personal care. Your Medical Proxy is concerned with all aspects of your future care, such as where to live; whether or not you have special dietary or clothing needs, and if so, to ensure these needs are accommodated; arranging for additional help to assist you in daily living, should you gradually come to need this.
Who to Appoint
Your Medical Proxy must be over 18 years of age, someone who knows you well and whom you trust to carry out your wishes. You should not appoint anyone who provides you with health care or support services for compensation, unless you are sure there is no conflict of interest. Any Medical Proxy involved in your care must be authorised by name and not by the title of the position they occupy.
You have the option to appoint more than one Medical Proxy. In this instance you should name one person as Primary Medical Proxy, and the next person as Alternate Medical Proxy. If you name more than one person, you may choose to have them act jointly or act independently.
Having them act jointly means they must all agree on all decisions before action can be taken. This can lead to disagreements or misunderstandings, and can be very time-consuming.
Having them act independently means that if the person you named as Primary Medical Proxy is unavailable or unable to act on your behalf, the person you named as Alternate Medical Proxy is automatically authorised to assume the duties.
We advise that you name your Medical Proxies to act independently.
Is your Medical Proxy up for the job?
Crucial questions to have your Medical Proxy consider before agreeing to become your Medical Proxy.
Every Advance Directive needs both a ‘what’ (a document outlining the patient’s treatment preferences) and a “who” (an individual who will speak for a patient who can’t speak for themselves).
"Pulling the Plug" is a term used to include everything from turning off a ventilator to withdrawing medically assisted nutrition and hydration and, for clarity, the Medical Proxy will not, themselves, physically withdraw treatment or ‘pull the plug’. This task is assigned to the medical practitioner.
- Will I ‘pull the plug’? A Medical Proxy may be called upon to refuse consent to or authorise discontinuation of life-sustaining medical care. If religious or moral views could prevent you from ensuring the patient’s wishes are carried out, you should decline the role
- Can I ‘pull the plug’? Sometimes the most likely candidates to serve as a Medical Proxy aren’t the best ones because they are too close to the patient. Emotions can cloud their thinking. Spouses in particular have been known to falter when it comes to a decision on ending futile treatment, even when they know it is what the patient wants. They simply can’t bring themselves to ‘pull the plug’.
- Can I ‘pull the right plug’? Am I able to understand the medical decisions involved and willing to spend the time to really understand the diagnosis, treatment alternatives and potential side effects? It’s important to be willing to act, but it’s just as essential to make competent, informed decisions. Medical terminology and possible treatments are contained at the end of the Planning Guide.
- Am I willing to be an advocate? In the best of all possible worlds, you’ll reach your decisions and find that the patient is treated accordingly. But sometimes you’ll need to challenge the system and advocate for the patient. Why is the terminal patient still being given blood tests when her body language indicates they hurt? Why is a patient suffering advanced dementia being given antibiotics when you know he didn’t want any life-prolonging measures? As the Medical Proxy on the scene, you have a critical role to play.
- Am I young enough for the job? It’s one thing to say yes, quite another to have the health and energy to do it when the time comes. And that time may not come for several years.
- Am I willing to say “it’s not about what I would want. It’s what you want?” This is the most critical test. Everyone is different, and we all have different ideas about end of life care. We may want to literally keep fighting for our lives and decide to accept all appropriate medical care or we may want a gentle death and decide to stop unwanted treatment. As a Medical Proxy, you must set aside your personal values and act in accordance with the patient’s wishes.