Advance Directive – Health Care Proxy
Appointing Your Health Care Agent
The New York Health Care Proxy Law allows you to appoint someone you trust – for example, a family member or close friend – to make health care decisions for you if you lose the ability to make decisions yourself. By appointing a health care agent, you can make sure that health care providers follow your wishes. Your agent can also decide how your wishes apply as your medical condition changes. Hospitals, doctors and other health care providers must follow your agent’s decisions as if they were your own. You may give the person you select as your health care agent as little or as much authority as you want. You may allow your agent to make all health care decisions or only certain ones. You may also give your agent instructions that he or she has to follow. This form can also be used to document your wishes or instructions with regard to organ and/or tissue donation.
About the Health Care Proxy Form
This is an important legal document. Before signing, you should understand the following facts:
1. This form gives the person you choose as your agent the authority to make all health care decisions for you, including the decision to remove or provide life-sustaining treatment, unless you say otherwise in this form. “Health care” means any treatment, service or procedure to diagnose or treat your physical or mental condition.
2. Unless your agent reasonably knows your wishes about artificial nutrition and hydration (nourishment and water provided by a feeding tube or intravenous line), he or she will not be allowed to refuse or consent to those measures for you.
3. Your agent will start making decisions for you when your doctor determines that you are not able to make health care decisions for yourself.
4. You may write on this form examples of the types of treatments that you would not desire and/or those treatments that you want to make sure you receive. The instructions may be used to limit the decision-making power of the agent. Your agent must follow your instructions when making decisions for you.
5. You do not need a lawyer to fill out this form.
6. You may choose any adult (18 years of age or older), including a family member or close friend, to be your agent. If you select a doctor as your agent, he or she will have to choose between acting as your agent or as your attending doctor because a doctor cannot do both at the same time. Also, if you are a patient or resident of a hospital, nursing home or mental hygiene facility, there are special restrictions about naming someone who works for that facility as your agent. Ask staff at the facility to explain those restrictions.
7. Before appointing someone as your health care agent, discuss it with him or her to make sure that he or she is willing to act as your agent. Tell the person you choose that he or she will be your health care agent. Discuss your health care wishes and this form with your agent. Be sure to give him or her a signed copy. Your agent cannot be sued for health care decisions made in good faith.
8. If you have named your spouse as your health care agent and you later become divorced or legally separated, your former spouse can no longer be your agent by law, unless you state otherwise. If you would like your former spouse to remain your agent, you may note this on your current form and date it or complete a new form naming your former spouse.
9. Even though you have signed this form, you have the right to make health care decisions for yourself as long as you are able to do so, and treatment cannot be given to you or stopped if you object, nor will your agent have any power to object.
10. You may cancel the authority given to your agent by telling him or her or your health care provider orally or in writing.
11. Appointing a health care agent is voluntary. No one can require you to appoint one.
12. You may express your wishes or instructions regarding organ and/or tissue donation on this form.
Frequently Asked Questions
If you become unable, even temporarily, to make healthcare decisions, someone else must decide for you. Healthcare providers often look to family members for guidance. Family members may express what they think your wishes are related to a particular treatment. However, in New York State, only a healthcare agent you appoint has the legal authority to make treatment decisions if you are unable to decide for yourself. Appointing an agent lets you control your medical treatment by:
• allowing your agent to make healthcare decisions on your behalf as you would want them decided; • choosing one person to make healthcare decisions because you think that person would make the best decisions;
• choosing one person to avoid conflict or confusion among family members and/or significant others. You may also appoint an alternate agent to take over if your first choice cannot make decisions for you.
Anyone 18 years of age or older can be a healthcare agent. The person you are appointing as your agent or your alternate agent cannot sign as a witness on your Healthcare Proxy form. How do I appoint a healthcare agent?
All competent adults, 18 years of age or older, can appoint a healthcare agent by signing a form called a Healthcare Proxy. You don’t need a lawyer or a notary, just two adult witnesses. Your agent cannot sign as a witness. You can use the form printed here, but you don’t have to use this form.
Your healthcare agent would begin to make healthcare decisions after your doctor decides that you are not able to make your own healthcare decisions. As long as you are able to make healthcare decisions for yourself, you will have the right to do so.
Unless you limit your healthcare agent’s authority, your agent will be able to make any healthcare decision that you could have made if you were able to decide for yourself. Your agent can agree that you should receive treatment, choose among different treatments and decide that treatments should not be provided, in accordance with your wishes and interests. However, your agent can only make decisions about artificial nutrition and hydration (nourishment and water provided by feeding tube or intravenous line) if he or she knows your wishes from what you have said or what you have written. The Healthcare Proxy form does not give your agent the power to make non- healthcare decisions for you, such as financial decisions.
Appointing a healthcare agent is a good idea even though you are not elderly or terminally ill. A healthcare agent can act on your behalf if you become even temporarily unable to make your own healthcare decisions (such as might occur if you are under general anesthesia or have become comatose because of an accident). When you again become able to make your own healthcare decisions, your healthcare agent will no longer be authorized to act.
Your agent must follow your wishes, as well as your moral and religious beliefs. You may write instructions on your Healthcare Proxy form or simply discuss them with your agent.
Having an open and frank discussion about your wishes with your healthcare agent will put him or her in a better position to serve your interests. If your agent does not know your wishes or beliefs, your agent is legally required to act in your best interest. Because this is a major responsibility for the person you appoint as your healthcare agent, you should have a discussion with the person about what types of treatments you would or would not want under different types of circumstances, such as:
• whether you would want life support initiated/continued/removed if you are in a permanent coma; • whether you would want treatments initiated/continued/removed if you have a terminal illness;
• whether you would want artificial nutrition and hydration initiated/withheld or continued or withdrawn and under what types of circumstances.
No. Your agent is obligated to make decisions based on your wishes. If you clearly expressed particular wishes, or gave particular treatment instructions, your agent has a duty to follow those wishes or instructions unless he or she has a good faith basis for believing that your wishes changed or do not apply to the circumstances.
All hospitals, nursing homes, doctors and other healthcare providers are legally required to provide your healthcare agent with the same information that would be provided to you and to honor the decisions by your agent as if they were made by you. If a hospital or nursing home objects to some treatment options (such as removing certain treatment) they must tell you or your agent before or upon admission, if reasonably possible.
You may appoint an alternate agent to decide for you if your healthcare agent is unavailable, unable or unwilling to act when decisions must be made. Otherwise, healthcare providers will make healthcare decisions for you that follow instructions you gave while you were still able to do so. Any instructions that you write on your Healthcare Proxy form will guide healthcare providers under these circumstances.
It is easy to cancel your Healthcare Proxy, to change the person you have chosen as your healthcare agent or to change any instructions or limitations you have included on the form. Simply fill out a new form. In addition, you may indicate that your Healthcare Proxy expires on a specified date or if certain events occur. Otherwise, the Healthcare Proxy will be valid indefinitely. If you choose your spouse as your healthcare agent or as your alternate, and you get divorced or legally separated, the appointment is automatically cancelled. However, if you would like your former spouse to remain your agent, you may note this on your current form and date it or complete a new form naming your former spouse.
No. Your healthcare agent will not be liable for healthcare decisions made in good faith on your behalf. Also, he or she cannot be held liable for costs of your care, just because he or she is your agent.
No. A living will is a document that provides specific instructions about healthcare decisions. You may put such instructions on your Healthcare Proxy form. The Healthcare Proxy allows you to choose someone you trust to make healthcare decisions on your behalf. Unlike a living will, a Healthcare Proxy does not require that you know in advance all the decisions that may arise.
Instead, your healthcare agent can interpret your wishes as medical circumstances change and can make decisions you could not have known would have to be made.
Give a copy to your agent, your doctor, your attorney and any other family members or close friends you want. Keep a copy in your wallet or purse or with other important papers, but not in a location where no one can access it, like a safedeposit box. Bring a copy if you are admitted to the hospital, even for minor surgery, or if you undergo outpatient surgery.
Yes. Use the optional organ and tissue donation section on the Healthcare Proxy form and be sure to have the section witnessed by two people. You may specify that your organs and/or tissues be used for transplantation, research or educational purposes. Any limitation(s) associated with your wishes should be noted in this section of the proxy. Failure to include your wishes and instructions on your Healthcare Proxy form will not be taken to mean that you do not want to be an organ and/or tissue donor.
Yes. As of August 26, 2009, your healthcare agent is authorized to make decisions after your death, but only those regarding organ and/or tissue donation. Your healthcare agent must make such decisions as noted on your Healthcare Proxy form.
It is important to note your wishes about organ and/or tissue donation to your healthcare agent, the person designated as your decedent’s agent, if one has been appointed, and your family members. New York Law provides a list of individuals who are authorized to consent to organ and/or tissue donation on your behalf. They are listed in order of priority: your healthcare agent; your decedent’s agent; your spouse, if you are not legally separated, or your domestic partner; a son or daughter 18 years of age or older; either of your parents; a brother or sister 18 years of age or older; or a guardian appointed by a court prior to the donor’s death.