If you have been considering a medical/healthcare proxy, also known as a medical power of attorney, you may have already begun to think about whom you wish to name as your Agent and his/her alternative together with the instructions you want give for your care if you are unable to express your wishes. If you are one of almost 25 million Americans who already have a proxy, you may want to revisit certain issues, especially in light of the public and private tragedy experienced by Terry Schiavo’s family. A medical/healthcare proxy ensures that everyone, regardless of family circumstances, retains control over his/her health care. Without a written proxy, partners or other loved ones may not be able to participate in decisions regarding medical treatment, your care decisions may be made by someone lacking knowledge of your wishes, making it more likely that you could be given treatment that you would not have chosen for yourself.
This article is an overview of the issues and is intended to assist you in making an informed decision. While not everything may be applicable to your individual situation and it certainly is not intended to replace legal advise, basic signposts are suggested to help guide you through a frequently emotional process, but one which nevertheless must be addressed…sooner rather than later.
It is important to make informed and considered decisions, especially relating to the selection of your Agent and his/her alternative in the event he/she is unable to serve, and to establish clear and concise instructions for your care. Remember that the need for a proxy is not limited to end of life situations, but any situation in which you are unable to make your own decisions, even if it is only for a short period of time. You will need to have candid discussions with your proposed Agent and ensure that he/she will fulfill YOUR wishes irrespective of his/her own feelings. The Agent is to make the same decisions you would make if you were able to do so. It is important to periodically revisit your instructions as circumstances may change.



Getting Started
There are three basic areas to consider before preparing a medical/healthcare proxy (power of attorney) or when you are reviewing your existing proxy:

• Explore your own circumstances

• Identify individual(s) you want to make treatment decisions for you in the event you are unable to make them for yourself

• List specific instructions (if any) you want to tell your Agent(s)

Exploring your own circumstances
There are a number of questions that you may wish to consider before preparing a medical/healthcare proxy (power of attorney) or when you periodically review your proxy:

1. What is the present condition of my health?

2. Do I have special medical needs?

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

4. What do I value most about life?

5. How do I feel about death or dying?

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

7. What circumstances would make me think that treatment to prolong life should or should not be used?

8. Is the amount of pain I am experiencing or will experience a consideration?

9. Does it make a difference if the pain is temporary or permanent?

10. Is the likelihood and degree of recovery a consideration?

11. Is my age a consideration?

12. Is the age of my spouse/partner (if any) or the ages of my children (if any) a consideration?

13. Should financial considerations influence decisions about my medical care.

14. Are there other beliefs or values that I hold that should be taken into consideration by those making medical decisions for me?

Selecting an Agent(s)

There are also questions you may wish to consider before selecting an Agent(s):

1. Is there someone who is already familiar with your overall medical situation?

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

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

4. Is there someone who is willing to participate in health care decisions on your behalf as your advocate and conscience?

5. Is there someone who is able to act on your behalf considering that person’s age, availability and location?

6. Is there anyone able to make tough decisions should it become necessary to do so?

7. Is there anyone able to understand important and possibly difficult medical information?

8. Are you confident that your choice will make the best decisions on your behalf consistent with your wishes?

Specific instructions

Whatever one’s age, current health or family history, no one knows when circumstances may arise that may render any of us unable to participate, whether temporarily or permanently, in critical medical decisions affecting our care. It is essential that a variety of scenarios be considered in which an Agent(s) may be required to act and make decisions.

1. Treatments considerations
   
   a. Limitations regarding types of medications (if any), including pain relief.
   b. Limitations regarding surgical procedures (if any).
   c. Limitation regarding nutrition and hydration treatments (if any), including feeding tubes.
   d. Limitations regarding artificial respiration (if any), including CPR.
   e. Limitations regarding alternative or experimental treatment (if any
    

2. Organ donation
    

3. Withdrawal of life support
   
   a. Degree of severity of condition
   b. Degree of permanence
   c. Degree of pain
   d. Financial costs
   e. Overall quality of life

Revisiting Your Choices

Planning is an ongoing process. It is important to regularly examine your choices periodically and whenever circumstances change. The list of questions posed above should be reviewed no less than annually, regardless of the difficulty associated with having to confront emotionally difficult issues. Not having a proxy is tantamount to crossing a busy intersection, against the light, without even looking.
Once you have selected your Agent(s), prepared and signed a proxy, then what? Unless your proxy information is available in the event of an emergency, all the effort you have undertaken is wasted.
medproxy.com is a member of the online-registries, Inc. family of web based digital medical records sites. medproxy.com permits the safe, secure, simple, affordable and private storage and retrieval of your proxy information combined with the ability to access and share those records with designated emergency healthcare providers.
In an emergency, medproxy.com offers accredited hospitals and healthcare organizations the ability to read your proxy information, learn the identity of your Agent(s) and how to contact them. In addition, whenever your proxy is accessed by a hospital, your Agent(s) will be immediately notified by email with the name, address and phone number of the hospital.
A medproxy.com member will have “peace of mind-online”® knowing that his or her wishes will be honored in the event of an emergency and the caregiver will have the security of knowing that the treatment being provided is consistent with the patient’s wishes.

Only subscribers can enter or alter their data, however accredited hospitals or anyone to whom you give your password may access this data on a read-only basis.
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 $9.95.

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