By David Stern

February 2003

Introduction
If you are considering a medical/healthcare proxy (power of attorney), you may have begun to think about whom you wish to name as your Agent and Alternate Agent, and what instructions you want to give him/her for your care. This article presents general information that may or may not apply to your situation. It is intended to assist you in making very important decisions, but does not constitute legal advice. Because laws vary from state to state, you may wish to seek legal counsel regarding your individual circumstances. 

It is important to make informed and considered decisions, especially related to your selection of an Agent and Alternate Agent and to establish instructions regarding your care. Ideally, you will have candid discussions regarding these issues with those you wish to appoint as Agent(s). You will want to ensure that he/she is willing and able to fulfill your wishes and make decisions on your behalf that are reflective of the decisions you would make if you were able to do so. It is also important to periodically revisit these decisions, as your circumstances change over time.

Getting Started
There are three areas to consider before preparing a medical/healthcare proxy (power of attorney).

• Explore your own circumstances.

• Identify individual(s) you want to make treatment decisions for you if you cannot make them for yourself.

• List specific instructions (if any) you would like to tell your agent(s)

Exploring your own circumstances

Below are listed a number of questions which you may wish to consider before preparing a medical/healthcare proxy (power of attorney):

1. What is the present condition of my health?

2. Do I have any special medical conditions?

3. Do I hold any religious or moral view about medicine or particular medical treatments?

4. What do I value most about life? 

5. How do I feel about death and dying? 

6. Do I believe life should be preserved as long as possible? 

7. Are there circumstances that would make me think life-prolonging treatment should (not) be used? 

8. Is the amount of pain I am experiencing (temporary/permanent) a consideration?

9. Is the likelihood of my recovery (none/partial/total) a consideration?

10. Is my age a consideration?

11. Should my (personal/family) financial considerations influence decisions about my medical care?  

12. Are there other beliefs or values I hold that should be considered by those making medical care decisions for me if I am unable to do so for myself?

Selecting an Agent/Alternate Agent

Below are listed a number of questions which you may wish to consider before selecting an Agent(s):

1. Is there anyone who is already familiar with your overall medical circumstances?    

2. Is there anyone who is already familiar with your wishes regarding medical treatment? 

3. Is there anyone who is already familiar with your personal/family circumstances that may affect/complicate treatment decisions?

4. Is that person willing to participate in the health care decisions on your behalf, acting as both your advocate and conscience?

5. Is that person, by virtue of age, availability and location, able to act as your Agent?

6. Is that person able to make tough decisions should it become necessary

7. Is that person able to understand important medical information affecting your treatment?

8. Are you confident that person will make the best decisions he/she can on your behalf?

All the same questions should be asked of an Alternate Agent
    
Specifying Instructions 

Whatever our age, whatever our current health, none of us knows when circumstances may arise which will render us unable to participate in medical decisions affecting our care. Therefore, you should consider a variety of scenarios in which others may be called upon to make decisions for you, even if your inability to make decisions on your own behalf is temporary. Whether your Agent(s) is aware of your wishes formally or informally, you should discuss possible scenarios with him/her.
 

1. Treatment considerations

• Limitations to types of medication (if any), including 
  pain relief.

• Limitations to surgical procedures (if any).

• Limitations to nutrition and hydration treatments (if any).

• Limitations to artificial respiration (if any), 
  including CPR. 

• Limitations to use of alternative or experimental treatment (if any).

2. Organ Donation

3. Are there any circumstances at which you would want treatment to sustain your life withdrawn?

• Degree of severity.

• Degree of permanence.

• Financial, emotional burden on others.

• Overall quality of life.

Revisiting Your Choices 
Planning is an ongoing process. It is important to regularly examine your choices. You should revisit the list of questions above whenever significant events or changes of circumstance dictate, or, at a minimum, once a year.
Once you have selected your agent (s), prepared a proxy and signed it, then what? Unless the proxy information is available in an emergency, all the effort you have undertaken is wasted.
medproxy.com is an Internet registry that permits the safe, secure, simple, affordable and private storage and retrieval of your proxy information. By registering at www.medproxy.com, any accredited hospital will be able to access your proxy information, learn the identity of your agent(s) and how to contact them. In addition, whenever your proxy information is accessed by an accredited hospital, an e-mail will be sent to your proxy agent and alternate proxy agent with the hospital’s name, address and phone number.
There is an initial charge of $19.95 for registration, which allows members to update or change their own proxy information whenever they choose, at no additional cost. There is an annual charge of $4.95 for members under age 65. There is no annual charge for members over age 75.
medproxy.com is a member of online-registries’ suite of web-based services that also includes kidrecords.com and senior-records.com, allowing individuals and families to manage their personal medical information and to share that information within a preauthorized constituency of “need-to-know” individuals. Only subscribers can enter or alter their data; hospitals may access this data on a read-only basis.
 

David Stern is a graduate of Harvard College and Harvard Law School and the founder of online-registries, Inc., a family of Web-based healthcare sites that includes medproxy.com, senior-records.com and kidrecords.com. Visit www.online-registries or call (401) 841-5600