Advance Directives Help Ensure Your Rights
Health Care Proxies Ensure Your Wishes Are Followed
By Julia C. Bonney
In 1991, New York State passed the Health-Care Proxy Law
which allows a competent adult to delegate the authority to make health-care
decisions, should he or she become unable to do so, to another adult.
health-care proxy is a simple, yet powerful, tool. By
appointing an agent to act on your behalf when you cannot, you help to ensure
that your health-care wishes will be carried out. Among your rights as a
patient are the right to participate in decisions regarding your course of
treatment, and the right to accept or refuse medical or surgical intervention.
You also have the right to formulate advance directives, such as the desire not
to be put on life-support systems should your condition be diagnosed as
How medical directives work
a health-care proxy to act on your behalf is not complicated; it does not
require a lawyer or third-party assistance. It does require you to select an
individual who knows you well and who will agree to act as your agent. We
suggest that you select two individuals, a primary and a secondary health-care
proxy, in the event that your primary agent is not
able to act on your behalf. Typically proxies are spouses, significant others, adult children, or close friends: they should be people with
whom you are comfortable talking about your beliefs and desires regarding
health-care decisions and terminal illness. Having a conversation with your physician
is also a very good idea.
medical directives do not need to cover every possible medical scenario. The
role of your health-care proxy is to represent your wishes and to take an
active part in the decision-making process, based on information from the
health-care provider responsible for your care. The best way to ensure this is
for you to have a conversation about your preferences at a time when you are
well, prior to the onset of any serious illness or injury.
for someone to act as your health-care proxy, you should have a signed,
witnessed, advance directive in your medical records both at your primary care
physician's office and at the medical center. Advance directive forms can be
obtained at either place. To have one sent to you from Cayuga Medical
Center, simply call (607)
find that families have not had these important discussions prior to
hospitalization. In cases of extreme medical urgency, this can have a
tremendous impact on the course of treatment. The most difficult and poignant
situations involve decisions around life support. If the hospital or medical
center has no advance directive naming a health-care proxy, and if there has
been no previous conversation with the patient about his or her wishes, the
removal of life support is extremely difficult. According to New York State
law, life support cannot be discontinued without clear and convincing evidence
of the patient's wishes, and without that evidence, the medical center is
powerless to act. Moreover, your agent must know your specific wishes regarding
the withholding or withdrawal of artificial nutrition and hydration. Under the
law, hospitals are required to provide nourishment in the absence of evidence
that such a course of treatment is contrary to the patient's wishes.
Everyone should have a proxy
people believe that advance directives are only for the elderly or terminally
ill. In fact, every adult should have an advance directive in place.
Life-threatening illness and injury that render patients temporarily
incompetent can happen at any age.
work in acute health care see firsthand the benefit of advance directives. When
families face difficult decisions regarding the care of a loved one, they are
typically more comfortable with the decisions they make when an advance
directive is in place. They have had conversations about these important issues
with their loved one and know his or her desires regarding extreme measures,
life support, the use of antibiotics, and a range of other questions that
surface in the course of medical emergencies and terminal illness.
at Cayuga Medical Center
are making a concerted effort to talk with patients about advance directives.
But in the best of all worlds, the hospital is not the time or place for these
decisions. Talk to your family when you are well and under no pressure to make
important life decisions. Your entire family will benefit.
Julia Bonney of Bonney
Communications is a medical writer for Cayuga Medical