Choosing Who Speaks for You

What a health care proxy is

A health care proxy is the person you legally authorize to make medical decisions on your behalf if you lose the ability to make them yourself — after a stroke, under sedation, in advanced dementia. Depending on your state, the role may be called a health care agent, a health care representative, or a durable power of attorney for health care. Naming one is a core part of advance care planning, the work of deciding ahead of time how you want to be cared for 1Ref 1National Institute on Aging (NIH) (2022).End of Life.That advance care planning — deciding ahead of time how you want to be cared for near the end of life, including who will make decisions for you — is a recognized part of end-of-life care..

The proxy speaks only when you cannot. As long as you can express your own wishes, you remain the decision-maker; the proxy's authority is a backup that activates when clinicians determine you no longer have capacity. That is why the choice deserves real thought — this is the voice that will stand in for yours at the very moment you are least able to correct it.

What makes a good proxy

The best proxy is not automatically your spouse, your oldest child, or the relative who would be hurt to be passed over. It is the person most able to do a hard job well. Weigh a few qualities honestly, because the wrong strengths in a person you love can still make a poor proxy.

• Will honor your wishes, not their own. A proxy's task is to choose as you would, even where they would choose differently for themselves.
• Stays steady under pressure. Medical crises are frightening; you want someone who can hear bad news and still think clearly.
• Can be assertive. A good proxy asks questions, pushes back, and holds the line with a busy medical team.
• Is reachable. Someone who travels constantly or is hard to reach cannot decide in real time.

It is worth naming a backup as well, in case your first choice is unavailable when it counts. And it is entirely acceptable to choose a devoted friend over a relative if that friend simply fits the role better.

Proxy, living will, and POLST are not the same

These three documents get confused constantly, and they do different jobs. A health care proxy names a person to decide for you. A living will is a document that states your wishes in advance — for example, whether you would want a breathing machine — but it cannot anticipate every situation. A POLST (Physician Orders for Life-Sustaining Treatment) is different again: it turns treatment preferences into portable medical orders that a clinician signs, and studies find the care people actually receive is largely consistent with what their POLST says 2Ref 2Peer-reviewed systematic review (see article) (2021).Are We Getting What We Really Want? A Systematic Review of Concordance Between POLST Documentation and Subsequent Care Delivered at End-of-Life.That a POLST translates treatment preferences into portable medical orders, and that end-of-life care delivered is largely concordant with POLST documentation..

Most people benefit from having a proxy and a statement of wishes together. The document tells your proxy what you value; the proxy applies that judgment to the specific, messy decision in front of them. A POLST is generally meant for people who are already seriously ill, not for healthy adults planning ahead. Choosing who speaks for you is the piece that makes the rest of it usable.

The conversation that makes it work

Naming a proxy and never telling them your wishes is the most common mistake, and it leaves them guessing at the worst possible moment. The point is to hand over not just authority but understanding. A structured goals of care conversation — what you would trade for more time, what an unacceptable outcome looks like to you, what matters more to you than length of life — gives your proxy something concrete to act on.

Shared-decision frameworks used in clinics translate well to this kitchen-table version. AHRQ's SHARE Approach walks through five steps: seek the person's participation, help them compare options, assess what they value, reach a decision together, and evaluate it 3Ref 3Agency for Healthcare Research and Quality (2020).The SHARE Approach.That AHRQ's SHARE Approach is a five-step shared-decision model: seek the person's participation, help them compare options, assess values and preferences, reach a decision together, and evaluate it.. To be sure your proxy actually absorbed what you meant, ask them to say it back to you in their own words — the teach-back technique clinicians use to confirm understanding 4Ref 4Agency for Healthcare Research and Quality (2024).Health Literacy Universal Precautions Toolkit, 3rd Edition.That teach-back — asking a person to restate information in their own words — is an evidence-informed technique for confirming that they understood.. These talks are hard, but the evidence favors having them: patients who discussed end-of-life care received less aggressive treatment near death, without more distress, and their families coped better afterward 5Ref 5Wright AA, Zhang B, Ray A, et al. (2008).Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment.That end-of-life discussions were associated with less aggressive care near death, no increase in patient distress, and better caregiver bereavement adjustment..

Making it official

Turning your choice into a valid document is usually straightforward, though the exact form and signing rules vary by state. In general, states provide a health care proxy or advance directive form, and completing it may require witnesses or a notary. The form is only useful if people can find it, so the real work is distribution, not signing.

• Give a signed copy to your proxy and to your backup.
• Give one to your primary doctor and any specialist involved in your care, and ask that it go into your medical record.
• Keep a copy somewhere findable at home, and tell your proxy exactly where it is.
• Revisit it after major life changes — a divorce, a move, a new diagnosis, a death in the family.

Because the rules differ from state to state, it is worth confirming your own state's specific form and witnessing requirements rather than assuming a document from elsewhere will hold.

What a proxy can and cannot do

A health care proxy's authority has clear edges, and knowing them prevents conflict later. The proxy decides only medical questions, and only once clinicians judge that you cannot decide for yourself; it is not a license to override you while you still have capacity. It is also separate from a financial power of attorney — the person who manages your money may or may not be the same person who manages your care.

Within those limits, a proxy can consent to or decline treatments, weigh care options, and help with choosing a level of care as your needs change. In illnesses like dementia, where capacity fades gradually, naming a proxy early — well before the signs it's time for memory care — matters, because the choice is far harder to make once judgment is already slipping. A proxy who truly knows your values can carry a comfort care only decision, or a choice like conservative kidney management over dialysis, the way you would have wanted.