A health care proxy is a person you legally designate to make medical decisions on your behalf if you become unable to communicate those decisions yourself. The term also refers to the legal document that names this person. It’s one of the most important forms of advance directive, and unlike a living will, it covers situations you may not have anticipated in writing.
How a Health Care Proxy Works
When you appoint a health care proxy (also called a health care agent, surrogate, or representative), you’re giving someone the legal authority to speak for you with doctors, nurses, and hospital staff. This person works directly with your medical team to make sure your care preferences are followed. The legal document that establishes this arrangement is called a durable power of attorney for health care, though the exact name varies by state. Some states call it a medical power of attorney.
The key word is “durable.” Unlike a standard power of attorney, which can expire if you become incapacitated, a durable power of attorney for health care is specifically designed to remain in effect when you can no longer speak for yourself. That’s the whole point.
When the Proxy’s Authority Begins
Your health care proxy has no authority over your medical decisions while you’re able to make them yourself. The document only activates when your attending physician formally determines that you lack the capacity to make your own health care decisions. This determination must be made in writing and include the physician’s assessment of the cause, nature, extent, and probable duration of your incapacity. If the incapacity stems from a developmental disability or mental illness, the physician must have specialized training in those areas or consult with someone who does.
Once that written determination is made, your physician notifies both you and your proxy. At that point, the proxy becomes the primary point of contact for managing your care. If you later regain the ability to make decisions, your proxy’s authority ends and you resume control.
What a Proxy Can and Cannot Do
A health care proxy generally has broad authority over all medical decisions unless you specify limitations in the document. This can include decisions about treatments, surgeries, medications, and end-of-life care. The proxy’s job is to make the choices you would make if you could, based on conversations you’ve had and values you’ve shared.
There are clear boundaries, though. Your proxy is not responsible for your medical bills or any debts you hold. They have no authority over your finances or property. Their role is strictly limited to health care decisions. Under federal privacy law, your proxy does have the right to access your medical records to the extent needed to fulfill that role. There is one exception: if a health care provider reasonably believes you may have been subjected to abuse or neglect by your proxy, the provider can refuse to treat that person as your representative.
Health Care Proxy vs. Living Will
These two documents serve related but different purposes, and understanding the distinction matters. A living will is a written statement of your wishes. It describes your goals for medical treatment, your religious or spiritual beliefs as they relate to care, and your instructions for specific situations, like whether you want life-sustaining treatment if you’re terminally ill.
A health care proxy, by contrast, is a person. Instead of writing out instructions for every possible scenario (which is impossible), you’re trusting someone to interpret your values and make real-time decisions as situations arise. This is why many experts recommend that if you only do one, naming a health care proxy should be the priority. A living will can’t adapt to unexpected circumstances. A trusted person can.
You can have both. If you do, make sure your proxy knows what’s in your living will and understands your reasoning. The proxy can then handle any situation the living will doesn’t cover.
Who Can Serve as Your Proxy
You can choose almost any adult: a spouse, partner, adult child, sibling, close friend, or anyone you trust deeply. The person doesn’t need legal training or medical knowledge. What matters most is that they understand your values, can handle difficult conversations under pressure, and will advocate for what you want rather than what they would want.
Some people are typically barred from serving as your proxy. Rules vary by state, but your attending physician and the administrator of any nursing home where you receive care are commonly ineligible. The logic is straightforward: the people providing or overseeing your care shouldn’t also be the ones making decisions about it.
How to Make It Legal
Requirements for executing a valid health care proxy document differ by state. Some states require notarization. Others require two adult witnesses to be present when you sign. Many states impose restrictions on who can serve as a witness. In Ohio, for example, no one related to you by blood, marriage, or adoption can witness the document. Your proxy, your attending physician, and any nursing home administrator are also ineligible as witnesses.
Most states offer a standard form you can download for free through your state’s health department or attorney general’s office. You don’t necessarily need a lawyer, but you do need to follow your state’s specific rules precisely, or the document may not hold up. Once completed, give copies to your proxy, your primary care provider, and any hospital where you receive regular care. Keep the original somewhere accessible.
Choosing the Right Person
This decision deserves real thought. Your proxy should be someone who can stay calm in a crisis, communicate clearly with medical professionals, and make hard choices without being paralyzed by emotion. They should be geographically accessible enough to respond when needed, though they don’t have to live nearby.
The most important step after choosing someone is talking to them. Tell your proxy how you feel about life-sustaining treatment, pain management, quality of life, and what “acceptable” looks like to you. These conversations aren’t comfortable, but they’re what allow your proxy to act with confidence rather than guilt. Consider naming an alternate proxy in case your first choice is unavailable or unwilling to serve when the time comes.
You can change your health care proxy at any time, as long as you still have the capacity to do so. Simply complete a new document and notify your previous proxy, your new proxy, and your medical providers.