Healthcare proxy

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In the field of medicine, a healthcare proxy (commonly referred to as HCP) is a document (legal instrument) with which a patient (primary individual) appoints an agent to legally make healthcare decisions on behalf of the patient, when the patient is incapable of making and executing the healthcare decisions stipulated in the proxy. [1] Once the healthcare proxy is effective, the agent continues making healthcare decisions as long as the primary individual is legally competent to decide. Moreover, in legal-administrative functions, the healthcare proxy is a legal instrument akin to a "springing" healthcare power of attorney. The proxy must declare the healthcare agent who will gain durable power attorney. This document also notifies of the authority given from the principal to the agent and states the limitations of this authority. [2]

Contents

Those over the age of 18 are allowed to have a healthcare proxy, and these documents are useful in situations that render a person unable to communicate their wishes such as being in a persistent vegetative state, having a form of dementia or an illness that takes away one's ability to effectively communicate, or being under anesthesia when a decision needs to be made. [3] Healthcare proxies are one of three ways that surrogate decision makers are enacted, the other two being court orders and laws for the automatic succession of decision makers. [4] In contrast to a living will, healthcare proxies do not set out possible outcomes with predetermined reactions, rather they appoint someone to carry out the wishes of an individual. [5]

History

The methods of healthcare planning and tools of advanced preparation have changed dramatically over the years. The concept of durable power of attorney arose in Virginia in 1954 for the purpose of setting property matters. This allowed for a continued existence of power of attorney following the original person losing capacity to carry out the necessary actions. This concept evolved over the years and in 1983, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research addressed this idea as one of great potential in the healthcare industry. This commission also stated the possibility of abuse as a noted concern going forward. In response to this commission, there was an evolution of this concept throughout the 1980s and the 1990s that eventually led to all states in America having a healthcare power of attorney statute by 1997. [6]

Criteria

Some jurisdictions place limitations on the persons who can act as agents. (Some forbid the appointment of treating physicians as the healthcare proxy.) [7] In any event the agent should be someone close to and trusted by the primary individual. [7] According to the state of Massachusetts, no person who is an employee or administrator of a facility can be an agent unless it is for someone who is of familial relation to them. In any event, the agent is recommended to be someone close to and trusted by the primary individual. In the absence of a power of attorney, a legal guardian must be appointed. [8]

Healthcare proxies are permitted in forty-nine states as well as the District of Columbia. [7] [9] Healthcare forms may differ in structure from state to state and pre-made forms are not compulsory as long as certain guidelines are met. The common guidelines include: [1]

Powers and limitations

The agent is empowered when a qualified physician determines that the primary individual is unable to make decisions regarding healthcare. The agent may be granted the power to remove or sustain feeding tubes from the primary individual if these tubes are the only things that are keeping the primary individual alive. The agent's decision should draw upon knowledge of the patient's desire in this matter. If the primary individual made his or her wishes clear on the proxy form, then they must be followed despite any possible objections from the agent.

A person may identify end-of-life decisions in more than one legal document, such as in a living will in addition to a healthcare proxy, in which case it is necessary to examine all of the documents to determine if any limit or revoke the agent's authority as granted in the healthcare proxy. [10] An agent will not be legally or financially liable for decisions made on behalf of the primary individual as long as they follow the terms of the healthcare proxy. [11]

Capacity to appoint

There are limited legal foundations to determine the ability of someone to appoint a healthcare proxy. Although physicians are allowed to deliver life-saving treatment in emergent situations, in non-emergencies, it is determined if the patient has the ability to then appoint a healthcare proxy. [4] It is possible for a patient lacking the ability to make healthcare decisions, to still have the capacity to appoint an agent and have a proxy.

United Kingdom

In England and Wales, an independent mental health capacity advocate may be appointed under the Mental Capacity Act 2005; the provisions made in the same Act for a lasting power of attorney may also provide a satisfactory basis for providing care via an attorney, who does not require to be professionally qualified. Different arrangements apply elsewhere in the UK.

See also

Related Research Articles

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Advance care planning is a process that enables individuals to make plans about their future health care. Advance care plans provide direction to healthcare professionals when a person is not in a position to make and/or communicate their own healthcare choices. Advance care planning is applicable to adults at all stages of life. Participation in advance care planning has been shown to reduce stress and anxiety for patients and their families, and lead to improvements in end of life care. Older adults are more directly concerned as they may experience a situation where advance care planning can be useful. However, a minority use them. A research conducted in Switzerland with people aged 71 to 80 showed that better knowledge on advance care planning dispositions could improve the perception older people have of them. Communication on dispositions should take into account individual knowledge levels and address commonly enunciated barriers that seem to diminish with increased knowledge.

Act 39 of 2013 established the U.S. state of Vermont's Patient Choice and Control at End of Life Act, which legalizes medical aid in dying with certain restrictions. Vermont was the first state to enact this Law through legislative action; it permits some terminally ill patients to determine the time of their own death.

In the law of England and Wales, best interest decisions are decisions made on behalf of people who do not have mental capacity to make them for themselves at the time the decision needs to be taken. Someone who has the capacity to make a decision is said to be "capacitous". Since 2007, there has been a dedicated court with jurisdiction over mental capacity: the Court of Protection, although it mostly deals with adults. Most applications to make decisions on behalf of a child are still dealt with by the Family Court.

References

  1. 1 2 "Health Care Proxy - New York State Department of Health" (PDF). New York State Department of Health. Archived from the original (PDF) on 2014-06-11.
  2. ↑ "General Law - Part II, Title II, Chapter 201D, Section 4". malegislature.gov. Retrieved 2018-10-30.
  3. ↑ "Healthcare Proxy - Who Will Speak for You?". www.health.ny.gov. Retrieved 2018-10-29.
  4. 1 2 Moye J, Sabatino CP, Weintraub Brendel R (April 2013). "Evaluation of the capacity to appoint a healthcare proxy". The American Journal of Geriatric Psychiatry. 21 (4): 326–36. doi:10.1016/j.jagp.2012.09.001. PMC   4859336 . PMID   23498379.
  5. ↑ "Health Care Proxy/Living Will | Stony Brook Medicine". www.stonybrookmedicine.edu. Retrieved 2018-10-29.
  6. ↑ Sabatino CP (June 2010). "The evolution of healthcare advance planning law and policy". The Milbank Quarterly. 88 (2): 211–39. doi:10.1111/j.1468-0009.2010.00596.x. PMC   2980344 . PMID   20579283.
  7. 1 2 3 Rai A (September 1999). "The Physician as a Healthcare Proxy". The Hastings Center Report. Hastings Center. Retrieved 2007-10-14.
  8. ↑ Hack J, Buecking B, Lopez CL, Ruchholtz S, Kühne CA (December 2016). "[Living will, durable power of attorney and legal guardianship in the trauma surgery routine : Data from a geriatric trauma center]". Zeitschrift für Gerontologie und Geriatrie (in German). 49 (8): 721–726. doi:10.1007/s00391-015-0981-1. PMID   26608036. S2CID   32809957.
  9. ↑ Health Care Powers of Attorney: Interactive Map, LawServer. Retrieved on August 19, 2014.
  10. ↑ Meier, Diane E.; Isaacs, Stephen L.; Hughes, Robert, eds. (2011). Palliative Care: Transforming the Care of Serious Illness. Germany: Wiley. p. 170. ISBN   978-1-118-03964-9.
  11. ↑ "Myths and Facts About Health Care Advance Directives" (PDF). ABA Commission on Law and Aging. American Bar Association. Retrieved 8 May 2017.

Further reading

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