Nothing is more difficult, and therefore more precious, than to be able to decide.”

Napoleon Bonaparte

Resources and workshops  

• IDOH https://health.ri.gov/forms/legal/DurablePowerOfAttorneyForHealthcare.pdf  

• IAARP https://www.aarp.org/caregiving/financial-legal/info-2019/health-care-surrogate.html  

Coming up: Bonnie Evans will be offering a fourth series of programs at Rogers Free Library in Bristol, beginning this September: “Let’s Talk About: Aging and Caregiving Matters.” These programs are meant to inform, inspire and to help make connections in our community. No need to register, come to one or all six. 

• Sept. 3 at 3 p.m: “A Guide to Having Difficult Conversations”  

• Sept. 10 at 3 p.m.: “Understanding Dementia-Related Behaviors”  

• Sept. 24 at 4:30 p.m.: “Medical Aid in Dying – A View from Both Sides”  

• Oct. 8 at 3 p.m.: “Services Across the Care Continuum”

• Oct. 22 at 3 p.m.: “Food, Illness & Nourishment”

• Nov. 19 at 3 p.m.: “Our Own Death Café” (with tea and cake).  

For more information, go to: rogersfreelibrary.org/featured-programs/

The Patient Self-Determination Act passed in 1991 mandates that health care organizations receiving federal funds inform all patients of their right to make decisions regarding their medical care and the right to appoint a Health Care Proxy (HCP). The HCP becomes effective when it is determined by a physician that you are no longer able to make decisions regarding your medical treatment. It could be temporary, or permanent, due to an illness or injury that incapacitates a patient.

If the medical condition improves and the individual regains decision-making ability, the HCP would be revoked.

It may seem obvious that you should choose the person closest to you to be your HCP, a spouse/partner, sibling, or best friend. However, there is much to consider when choosing a health care proxy.

Rhode Island law

In Rhode Island, the term used for health care proxy is Durable Power of Attorney for Health Care, and the law “gives the person you designate as your agent (the attorney in fact) the power to make health care decisions for you. Your agent must act consistently with your desires as stated in this document or otherwise made known” (Chap. 23 – 4.10).  A court can take away the powers of that agent if that individual authorize anything illegal or does anything that is clearly contrary to your best interest. 

The law requires that the individual who is appointing a Durable Power of Attorney for Health Care must be 18 years of age or older and a resident of Rhode Island. The form must be signed voluntarily and witnessed properly. The witnesses can be one notary or two adults who are NOT the health care proxy, a health care provider or employee of a health care provider or the operator or employee of a community care facility. This is to protect against competing roles in any decision making on your behalf.  No attorney is needed to complete this document, and it can be found on the Rhode Island Department of Health website.      

Your Durable Power of Attorney for Health Care form does not need to be renewed or updated but should be reviewed periodically to ensure that the information remains valid and that your wishes have not changed. The Rhode Island form asks for information regarding two alternate proxies, which is not required but is recommended in case the primary health care proxy is not available. 

Things to consider

The legal requirements are described above for choosing a proxy, but the overriding question to ask yourself is if you can trust this person with your life. Your proxy needs to be able to set aside their own perspectives and opinions and focus on your wishes. Would you be comfortable discussing your medical conditions, religious preferences or end of life care with this person?

In a moment of crisis or if conflict arises within the family or the health care system, would they be able to advocate for you? Do they live locally, or could they travel to be with you if needed?  Consider the age of the proxy as well and if they are likely to be available into the future?

Would a loved one be able to be objective enough to withhold or withdraw life sustaining treatments if that had been your wish? Will choosing one child over another create conflict? In some circumstances, a close friend or attorney might be the better option.        

The Rhode Island Durable Power of Attorney for Health Care form includes a general statement about the authority or power granted to a proxy and the option to outline any limitations to this power. A list of specific desires and provisions can be added as well. The primary power of a proxy is “to consent, to refuse to consent or to withdraw consent to any care, treatment, service, or procedure to maintain, diagnose, or treat a physical or mental condition.” Additional authority could extend to choosing where you receive health care, including residential care, assisted living, nursing home, hospice or hospital.

This would require a good understanding of your needs at the time, your previously stated wishes, and the available resources. Decisions around autopsy, organ donation, and care of the body after death might also be made based on your preferences.  Although there could be financial implications involved with these decisions, the responsibilities listed on the Durable Power of Attorney for Health Care form do not include handling your finances. That would require additional legal documents and an attorney. 

After making your choice

It follows that the more discussions you have with your proxy about your values and wishes regarding future health care and what brings meaning to your life, the better prepared they will be to make decisions on your behalf.  Are there life-sustaining treatments that you would or would not want in certain circumstanes? Sit down and have these important conversations.

It is not possible to cover every scenario, but knowing your basic thoughts regarding quantity versus quality of life can help to guide your proxy. Copies of the Durable Power of Attorney for Health Care should be shared with your proxy, any alternate proxies, your physician and family.  Ideally, it is downloaded into your medical records.  

The choice to be a health care proxy 

On the other hand, have you been asked by someone to be a proxy? This is an indication of their trust in you, but you need to be clear about what this could mean over time and under varying circumstances. You should ask yourself similar questions about being able to be an advocate by putting their wishes front and center, and can you be available? Do they have a living will and what does it say? What would you need to know to make the best decisions regarding their medical care?  

To choose a proxy or to consider becoming one requires careful thought and implies mutual trust and respect. Communication is the key to the process. Conversations around personal values, life goals, and spiritual beliefs all combine to assist in making the best healthcare decisions, not only for oneself, but especially when speaking on behalf of another.

Bonnie Evans, RN, MS, GNP-BC, GC-C, lives in Bristol and is a geriatric nurse practitioner, End of Life Doula, and certified grief counselor. She can be reached at bonnie@bonnieevansdoula.com.