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Advance care planning is a routine component of health care. It involves a discussion of an individual's wishes for future medical care in the event he or she becomes unable to make his or her own decisions about health care. These decisions can be for health care delivered at the end of life or at other times throughout the individual's life in which he or she is either permanently or temporarily incapable of making health care decisions.

This process involves an ongoing discussion between the person who asked you to serve as his or her proxy, your doctor and yourself. This discussion provides you with the opportunity to learn about the personal values, attitudes and beliefs regarding health care, illness and death held by this individual. In many instances these discussions are documented using an advance directive, living will or a durable power of attorney for health care.

What Is a Proxy Decision-Maker?

A proxy decision-maker is an individual who has been asked to represent a friend, a family member or a trusted acquaintance in the event that he or she is unable to express his or her wishes for health care. The proxy is charged with stating specific treatment choices, aiding in the interpretation of what would have been wanted, or attempting to assess treatment that is in the best interest of the person based on advance care planning discussions.

How Can I Get to Know What the Patient Might Want?

Whether or not specific instructions are going to be written down, it is important to get a good sense of how your friend or family member thinks about care in possible situations of life-threatening illness. A helpful way to do this is to be present when he or she meets with the doctor to discuss these issues. Some proxies offer to be the person who documents the individual's goals and treatment choices. This is also a good time to raise any concerns you might have if there is anything he or she is asking that concerns you, whether it is an issue in need of clarification or an action you disagree with.

What If My Role Makes Me Uncomfortable?

Being a proxy is a major responsibility. At any time in the discussion, if you want to withdraw from the role, you should do so. Being a proxy can be a hard job. Some people don't want to take on the role for fear of not being able - emotionally, intellectually or because of time constraints - to handle the situation. Sometimes a proxy has a conflicting perspective regarding health care requests and feels that representing the patient would be too difficult. These are reasonable concerns that may cause you to consider not accepting the role of proxy.

There are rewards, however, to serving as a proxy. Being chosen as a proxy is an honor that displays trust on the part of your friend or family member, and involves you in a team of care. If the role is completed with a sense of love and loyalty, then the proxy can help create a good experience for everyone involved.

If you do decide to decline the role, try to help your friend or family member think about who else might be a good choice to serve as his or her proxy. It need not be a family member or loved one. Another friend or colleague may be able and willing to serve in the role.

When Does My Proxy Authority Begin?

Usually your decision-making role begins when the patient is no longer able to make needed decisions for him- or herself. As long as the patient is able, it is important to ensure that he or she maintains the decision-making role.

What Do I Do When My Proxy Authority Begins?

It is important to keep whatever written documents you have handy, both to confirm your role and to indicate the patient's preferences. Speak with the doctor and other members of the health care team as soon as you can, so that they know you are involved. Stay in touch with the family so that there are no needless surprises. You should make yourself available for all medical decisions in which the patient would ordinarily be involved.

Remember that being a proxy may be hard work. Make arrangements for your own life and your own personal support so that you do not become overburdened.

What If I Change My Mind?

You can change your mind regarding serving as proxy at any point. Generally, it is best that you carefully consider the role well before the time when you are called to fulfill it.

If you change your mind prior to the time when you are called to serve in the role, you should notify your friend or family member immediately. The designation of a new proxy will be necessary and your assistance in this process will be helpful. Once another proxy is identified, your friend or family member will document the change on relevant forms and you will be free of your responsibility as proxy.

If you change your mind after you have been called to serve in the role, you should meet with your friend or family member's doctor immediately. If discussions with the doctor do not change your mind, he or she will select a surrogate decision-maker and you will be released from your responsibility.

Excerpted from: Damon K. Marquis, MA, MS. Advance Care Planning: A Practical Guide for Physicians. American Medical Association, 2001.

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See Related Articles:

• What Is Advance Care Planning: An Introduction for Physicians
• Advance Care Planning: Guidance for Patients
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