A living will allows you to document your wishes concerning medical treatments at the end of life. A medical power of attorney (or health care proxy) allows you to appoint a person you trust as your health care agent, who is authorized to make medical decisions on your behalf. 

Advance directives are legally valid throughout the United States. The laws governing advance directives vary from state to state, so sign advance directives that comply with your state's law. Also, advance directives can have different titles in different states.

Your health care agent should be a person whom you trust, who knows your wishes about medical treatment and who is willing to take responsibility to ensure your wishes are followed.

Appointing an agent or accepting such an appointment can raise questions you might 
never have considered. You may reach a deepened understanding of yourself and your relationship with the person you appoint or who appoints you. Taking time to talk about 
the issues can be a rewarding experience in itself.

SELECTING AN AGENT: 

Select someone whom you trust and who understands your decisions. Because you are asking your agent to accept significant responsibility, be certain to ask your agent if he 
or she is willing to act on your behalf. Not everyone is able to be an effective agent. 

Talk to your agent about your wishes regarding end-of-life medical treatment. Even family members may not know how much treatment a loved one would be willing to accept near the end of life. Talking clarifies what you want and diminishes an agent's potential guilt and anguish over whether he or she is doing the right thing. 

Prepare and sign the appropriate forms for your state. Keep the original and give copies to your agent and alternate agents, family and doctors and have it placed in your medical record. 

BENEFITS OF HAVING AN AGENT:

The agent knows you and understands your wishes about medical treatments. He or she can make decisions in situations you might not have anticipated. An agent has flexibility. He or she can talk with your physicians about your changing medical condition and authorize treatment or have it withdrawn as circumstances change. 

If you have prepared a living will, your agent can interpret it in situations that were not foreseen. Be sure to make clear in your living will that your agent should make decisions on how to interpret it or when to apply it. 

Your agent can advocate for you. If health care providers resist following your wishes, your agent can negotiate with them and take any other necessary steps to see that your wishes are honored. In most states, your agent can make decisions any time you lose the ability to make a medical decision, not just decisions about the end of life.

BEING A HEALTH CARE AGENT 

A health care agent is someone you designate to make medical decisions for you in the event that you are unable to make decisions for yourself. Selecting a health care agent for yourself or agreeing to be an agent for someone else requires preparation and communication. Often people don't know what issues to discuss. 

As the health care agent you have the power to make medical decisions if the patient loses the ability to make them on their own. Although this authority may vary some from state to state, you normally can make all medical decisions, not only end-of-life ones. 

However, be sure to read carefully the form that appointed you to see if there are any limitations or specific requirements established by the state, such as having specific knowledge about the patient’s wishes regarding artificial nutrition and hydration (tube feeding).

When asked to serve as a health care agent it is very important that you have open and frank conversations with the person who is asking you to serve. You need to know as much as possible about what the person’s wishes and values are regarding the use of medical technology, particularly if the person were diagnosed with a terminal or irreversible illness and unlikely to ever become able to speak for himself again. 

One of the agent’s most important functions is to be an advocate for the patient. This can involve asking to see medical records, meeting with the physician to get information about the patient’s diagnosis (what is wrong with the patient) and prognosis (what is likely to happen to the patient because of the disease or injury), as well as any other information needed to make decisions about treatment. 

You may need to be assertive and persistent in seeking information and in speaking up on the patient’s behalf. 

Acting as a health care agent

Providers and patients (or their agents) don't talk enough. As an agent, you will be responsible for working with providers to ensure that your loved one's wishes, including preferences about end-of-life treatments, are honored. If you become the decision maker for a loved one, take the following steps:

Establish open communication with the doctor. Identify the attending physician. Make an appointment to speak about your loved one's care. Be assertive in expressing your wishes. Clearly state the reasons behind your requests without being hostile. 

Ask questions. To be effective and to make informed decisions, learn as much as possible about your loved one's condition and prognosis. If you don't ask, the physician might not tell you everything you need to know to make an informed decision. Ask about the goals of the treatment plan- often, a physician's definition of recovery can be different from what is acceptable to you or your loved one. Some providers may have a hard time withholding or withdrawing treatments. 

Seek the assistance of a social worker or patient representative. Such professionals can help improve communication between you and the physician if necessary. 

Don't be afraid to speak to the facility's administration. If the physician is unresponsive, go directly to his or her superiors, including the chief of medicine, risk manager, hospital lawyer or administrator. 

Source: Partnership In Caring http://www.partnershipforcaring.org/