by Ben Jennings, Lead Advisor, CFP®
Over the last couple of months, we’ve been thinking together about the people involved in various aspects of your estate planning. We’ve addressed the needs of children and handled financial matters. Lastly, let’s discuss health care.
As we go through life, most of us come to find that managing health care is a complex task that we often wish were easier or less time-consuming. Managing someone else’s health care can be even more challenging!
You’ll begin by defining what you’re asking someone—your health care proxy—to handle on your behalf.
Your Health Care Proxy
First, you are asking them to follow and advocate for the desires you express in an advance directive (i.e., directions given in advance, in writing). These documents—called health care directives or living wills—spell out the specific procedures or approaches you may or may not want in particular health care circumstances. Additionally, there may be health situations not addressed by an advance directive in which your proxy will need to make decisions on your behalf.
So, what are the qualities to consider in the person you’re asking to fulfill this role as a surrogate decision-maker? Let me suggest several characteristics:
An ability to ask good questions and to process complex information.
The strength to honor previous commitments during emotionally charged times.
Willingness to consult with and make other loved ones feel heard, while ultimately accepting responsibility for making the decision you would expect them to make to the best of their ability (that is, not merely moderating a family council).
Location—being physically nearby may be more important for a health surrogate than for a financial surrogate; it enables better timeliness and communication.
Reason and sound decision-making.
Self-confidence to live with hard decisions and not second-guess themself.
Care and love without sentimentality.
Beyond your advance directive document, it’s important to communicate with your proxy regarding your preferences in various situations. Medicine is ever-evolving, as are care and treatment options. Our preferences for care can often shift when the moment of care arrives—life rarely happens exactly as we’d imagine it. So it is likely your proxy may have to go beyond the intent and preferences expressed in your advance directive. How do they do this?
Decisions That Define Care
Substituted Judgment
The proxy asks themself, “What would X want?” Under this standard, the proxy (agent) uses their knowledge of your values, beliefs, priorities, and any preferences you have previously expressed to guide their choice on your behalf.
Best Interest
When it’s not possible to use substituted judgment, they may instead use a “best interest” standard; your proxy will decide based on what they believe to be most beneficial for your overall well-being. “What is best for X?”
Supported Decision-Making
There is one more perspective or approach I want to mention. It may be that, rather than the proxy taking over decisions from you, it may be possible for them to consider the options for treatment collaboratively with you. We call this “supported decision-making”. It can be very helpful in complex situations—when you are overwhelmed and your internal resources are sapped—for your proxy to walk you through an assessment of the alternatives before you decide.
Your health care proxy is not just someone who “pulls the plug.” Their responsibility may be of brief or intense duration, but it’s also possible that they will partner with you and influence your health care over a long, long period of time.
We’re Here to Help
Your advisor at SoundView is ready to discuss aspects of this choice with you if you have questions, concerns, or need to weigh the different factors involved in the decision.