Advances in medical science enable us to extend lives years beyond what was possible even a few decades ago. Yet this progress has a potentially darker side: it can prolong suffering to patients and family alike and draws out the process of dying beyond what is natural and often longer than many people desire.

Nothing brings this reality into our lives more clearly than the recent battle over the life…and death of Terry Schiavo. The tragic circumstances pitted parent against spouse, Court against Congress and neighbor against neighbor. The nightly news reports surrounding the final days in the life of Terry Schiavo dramatized the painful, but avoidable plight relating to those who no longer have decision-making abilities. Proper advanced planning can ensure that a patient’s wishes are known and implemented, without the cost, both emotional and financial, that are indelibly associated with the tragic end of her life.

Concerns about legal rights and potential liabilities surrounding the care of patients incapacitated by illness or injuries cause many to receive undesired treatment or have treatment withheld or withdrawn. Respirators, feeding tubes and other mechanisms may be undesired at the end of life, but are used because there is no clear directive of what the patient wants.

Medical proxies, that are also known as healthcare proxies, advance directives or medical powers of attorney, were created to give incapacitated patients control over their treatment. Medical proxies are legal documents and are binding in all 50 states. An agent or surrogate acts on behalf the incapacitated patient to make treatment decisions. Proxies differ from living wills. In order to implement wishes regarding end of life decisions set forth in a living will, which many states do not recognize as binding in the absence of a proxy agent, the patient will need to designate, in writing, an individual and usually an alternate, to act on his/her behalf.

Although details of the laws governing medical proxies vary from state to state, agents may act only after the attending physician certifies that the patient is unable to make or communicate decisions. The agent may then make any decision that a patient would otherwise make, such as consent to or refusal of medical treatment. The patient can, in advance, issue specific instructions and stipulate exceptions or limits to the agent’s authority.

If you want to ensure that your treatment wishes are followed in the event of incapacity, you should follow these steps to create a medical proxy:

• Identify an agent. You need to identify an agent, and preferably an alternate agent as well. Your agent should be someone you trust who is willing and able to make crucial and often difficult decisions on your behalf.
   

• Determine your instructions. You should examine treatment alternatives and discuss what treatment you want with your physician, your attorney and family members. You also should make sure that your agent fully understands your instructions and is prepared to carry them out. It is suggested that your wishes be in writing.
   

• Draft your proxy. You should draft your medical proxy, either by yourself or in consultation with your physician or attorney. Sample forms are available through lawyers, many hospitals and Web sites devoted to legal and healthcare matters. At a minimum, the medical proxy must identify you and your agent and include contact information; state your intent that your agent have authority to make healthcare decisions in your behalf; state what limitations, if any, are imposed on the agent’s authority; and state that the agent’s authority begins only if you are unable to make healthcare decisions.
   

• Have your proxy witnessed. Once you are comfortable with your instructions, you should sign your medical proxy and have it witnessed by two individuals who are neither your agents nor caregivers nor relatives by blood, marriage or adoption. Since a medical proxy is a legal document, every effort should be made to ensure that your proxy complies with the specific requirements of the state in which you live.
   

• Make sure your proxy is accessible. The primary limitation of medical proxies is that physicians sometimes neither know that their patients have proxies nor have a way of finding out that they do. You should give copies of your medical proxy to your physician and designated agent(s). Your spouse, partner or family also should have a copy. Ideally, hospitals should be able to ascertain whether you have a proxy and whom to contact in the event of an emergency.
   

• Review your proxy regularly. You should review your medical proxy regularly, and update it to reflect any changes in your situation. For example, your proxy should include any changes in your agent’s contact information or in your treatment instructions. It’s best to review your proxy in connection with some regularly scheduled event, such as an annual consultation with your physician.

Leading professional groups, such as the American Medical Association and the American Bar Association, as well as advocates such as the American Association of Retired Persons, recognize the value of medical proxies as a solution to a patient’s inability to make vital decisions.

Without an executed medical proxy, spouses, partners or other trusted loved ones may not be able to participate in medical treatment decisions, and your healthcare decisions may be made by people lacking knowledge of your wishes. These simple steps will ensure that you receive only the treatment you want, sparing unwanted and costly treatment.
 

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