A healthcare proxy is a person you legally designate to make medical decisions on your behalf if you become too ill or incapacitated to make them yourself. The term also refers to the legal document that grants this authority. You might hear it called a healthcare agent, healthcare surrogate, or medical power of attorney, depending on your state. It is one of the most important parts of advance care planning, and any adult can create one.
How a Healthcare Proxy Works
A healthcare proxy has no authority over your medical care while you can still speak for yourself. The document only activates when a physician formally determines that you lack the capacity to make your own decisions. That determination involves assessing whether you can understand the relevant medical information, appreciate your situation and its consequences, weigh the risks and benefits of treatment options, and communicate a choice based on your own values.
If you later regain capacity, your proxy’s authority stops. The role switches on and off based on your current ability to participate in decisions, not on a one-time ruling.
What Decisions a Proxy Can Make
The scope of your proxy’s authority is broad, but you control how broad. You can give your proxy wide-ranging power over all medical decisions, or you can limit them to specific situations. Common responsibilities include:
- Medical treatment: Deciding which procedures, treatments, or services you receive, including life-sustaining measures like ventilators or feeding tubes.
- Care providers and facilities: Choosing your doctors and where you receive care.
- Health information: Accessing your medical records and information about your physical and mental health.
- End-of-life decisions: Making choices about organ and tissue donation, autopsy, and what happens to your body after death.
- Guardianship: Becoming your legal guardian if one is needed.
You can also build in conditions. For example, you might require your proxy to consult with certain family members before making a major decision, or you might reserve specific choices for your doctor. That said, giving your proxy some flexibility is important. Medical situations are unpredictable, and a proxy who is too constrained may not be able to advocate effectively for your best interests.
What a Proxy Cannot Do
A healthcare proxy covers medical decisions only. It does not give someone authority over your finances, property, legal affairs, or estate. If you want someone to manage those areas during incapacity, you need a separate document, typically called a durable power of attorney for finances. These are two distinct legal tools, and naming someone as your healthcare proxy does not automatically grant them any financial authority.
Healthcare Proxy vs. Living Will
A living will and a healthcare proxy serve related but different purposes. A living will is a written document that spells out your preferences for specific end-of-life scenarios in advance: whether you want CPR, mechanical ventilation, tube feeding, dialysis, comfort care, and similar interventions. It speaks for you, but it cannot adapt to situations you didn’t anticipate.
A healthcare proxy is a person, not a set of instructions. Your proxy can respond to the actual circumstances as they unfold, ask questions, weigh options the medical team presents, and make judgment calls in situations your living will never addressed. Most planning experts recommend having both. The living will gives your proxy a clear sense of your values and preferences, while the proxy fills in the gaps where a static document falls short.
Choosing the Right Person
Your proxy does not have to be a family member. It can be a spouse, adult child, sibling, close friend, or anyone you trust to honor your wishes under pressure. The person you choose should be someone willing to have difficult conversations with doctors, capable of separating their own emotions from your stated preferences, and available to respond quickly in an emergency. It helps to name an alternate proxy in case your first choice is unreachable or unable to serve when the time comes.
Think carefully before defaulting to the person closest to you emotionally. The best proxy is someone who can carry out your wishes even when those wishes conflict with what they personally want. A spouse who would struggle to authorize comfort-only care, for example, may not be the strongest choice if that aligns with your values. Have a direct conversation with your proxy about your preferences for treatment, pain management, and quality of life before anything is put on paper.
What Happens Without a Proxy
If you become incapacitated and have not named a healthcare proxy, your state has a default hierarchy for who gets to make medical decisions. While the specifics vary by state, the general order typically follows this pattern: a court-appointed guardian (if one exists), your spouse, a parent (for their child), a sibling, other close relatives, and finally an adult friend. This default system often works, but it can also lead to disagreements among family members, delays in critical care decisions, or someone making choices you would not have wanted. Naming a proxy in advance removes that ambiguity.
How to Create a Healthcare Proxy
Creating a healthcare proxy is simpler than most people expect. Every state provides its own form, often available for free through the state attorney general’s office or department of health. You do not need a lawyer, though consulting one can help if your situation is complex.
Most states require two adult witnesses to watch you sign the form and confirm that you appeared to do so willingly. Your chosen proxy and alternate proxy typically cannot serve as witnesses. Some states require notarization, others do not. In New York, for example, notarization is not necessary for a healthcare proxy, though it is recommended for a living will since some states that might need to honor it do require notarization.
Storing and Sharing the Document
A healthcare proxy is useless if no one can find it when it matters. Keep the original in a secure but accessible place in your home, and make sure your proxy knows exactly where it is. Harvard Health recommends distributing copies to your healthcare agent and any alternates, your primary care doctor (so it’s in your medical file), and close family members or friends who might be present in an emergency.
If you are admitted to a hospital, ask to have a copy placed in your chart. Carry a wallet card with your proxy’s name, phone number, and a note about where the original document is stored. The National Hospice and Palliative Care Organization suggests noting on every copy where the original is filed, so there is never confusion about which version is current.
Changing or Revoking a Proxy
You can change or revoke your healthcare proxy at any time, as long as you have the mental capacity to do so. The process is straightforward: create a new proxy document naming a different person, or simply revoke the existing one in writing. The change becomes legally effective once you communicate it to your proxy, your healthcare provider, or your healthcare facility. If you revoke it verbally rather than in writing, most states require that a third person be present as a witness.
Life changes like divorce, a falling out with your named proxy, or a move to a new state are all good reasons to revisit your documents. Review your healthcare proxy every few years, or any time your relationships or health circumstances shift significantly.