A healthcare proxy is a person you legally appoint to make medical decisions on your behalf if you become unable to communicate them yourself. The term also refers to the document that grants this authority. You might hear the same concept called a healthcare agent, surrogate, or representative, depending on your state.
What a Healthcare Proxy Actually Does
Your proxy works directly with your medical team to ensure your care preferences are followed when you can’t speak for yourself. That covers a wide range of decisions, not just dramatic end-of-life scenarios. Common responsibilities include deciding which medical treatments, procedures, or services you receive; choosing your healthcare providers and where you receive care; accessing your medical and mental health records; and making decisions about organ donation, tissue donation, and what happens to your body after death. In some states, your proxy can even become your legal guardian if one is needed.
The key principle behind all of this: your proxy is supposed to decide the way you would decide. They’re not imposing their own values. They’re standing in for you.
When a Proxy’s Authority Kicks In
Naming a proxy doesn’t hand over control of your medical care right away. In most cases, the proxy’s authority activates only when a physician determines you lack the capacity to make healthcare decisions, whether from unconsciousness, severe cognitive decline, sedation during surgery, or another condition that prevents you from communicating. If and when you regain that capacity, the proxy’s authority pauses.
Some healthcare power of attorney documents are written to take effect immediately upon signing. Others are triggered only by incapacity. The distinction matters, so it’s worth reading the specific language in your document carefully before signing.
Healthcare Proxy vs. Living Will
These two documents get confused constantly, but they do different things. A healthcare proxy names a person. A living will lists specific treatments you do or don’t want if you become terminally ill and can’t speak for yourself, such as mechanical ventilation, tube feeding, or resuscitation.
A living will is limited to the scenarios you anticipated when you wrote it. A healthcare proxy, by contrast, can respond to any medical situation that comes up, including ones you never predicted. That flexibility is a major advantage. Some states, like Massachusetts, don’t even officially recognize living wills as legally binding, though they can still serve as useful guidance for your proxy and your doctors. Many people choose to have both: a proxy to make decisions and a living will to inform those decisions.
Who Can Serve as Your Proxy
Most states require your proxy to be a legal adult. Beyond that, restrictions vary. Some states prohibit your treating physician from serving as your proxy due to conflict of interest. In general, people choose a spouse, adult child, parent, sibling, or close friend.
The right person isn’t necessarily your closest relative. The best proxy is someone who understands your values around medical care, can handle stressful conversations with doctors, and will advocate for what you want rather than what they want. It helps to choose someone who lives nearby or can travel quickly, since decisions sometimes need to happen fast. Naming an alternate proxy is also a smart move in case your first choice is unavailable.
What Happens If You Don’t Name One
If you become incapacitated without a healthcare proxy in place, most states fall back on a default hierarchy set by law. That order typically starts with your spouse or domestic partner, then moves to an adult child, a parent, a sibling, and then other relatives. A growing number of states also allow a close friend to serve as a default surrogate.
The problem with relying on this default system is that it can lead to disagreements among family members, delays in care, or decisions made by someone who doesn’t actually know your preferences. Naming a proxy in advance removes that ambiguity entirely.
How to Make It Legal
Creating a healthcare proxy is simpler than most people expect. Every state has its own form, often available for free from your state’s department of health or attorney general’s office. You fill it out, sign it, and have it witnessed. Most states require two adult witnesses. Some states prohibit certain people from serving as witnesses, for example, your proxy cannot typically witness the document, and in Florida, only one witness can be a spouse or relative.
Notarization is not required in most states, though some people choose to notarize it alongside other legal documents like a will. Once signed and witnessed, give copies to your proxy, your alternate proxy, your primary care doctor, and any hospital where you regularly receive care. Keep the original somewhere accessible.
Access to Your Medical Records
Under federal privacy law (HIPAA), a healthcare proxy who is currently authorized to act on your behalf has the same right to access your health information as you do. That includes your complete medical record, mental health records, and hospital records. There is one narrow exception: a psychotherapist’s personal session notes kept separate from your medical chart are not included.
There is also a safety provision. If a healthcare provider believes you have been or may be subject to violence, abuse, or neglect by the person named as your proxy, the provider can refuse to treat that person as your representative. This is a judgment call the provider makes based on your best interests.
Changing or Canceling Your Proxy
You can revoke your healthcare proxy at any time, as long as you have the mental capacity to do so. The process is straightforward: tell your proxy or your healthcare provider, either verbally or in writing, that you’re canceling the appointment. To name a new proxy, simply fill out a new form. The most recent valid document overrides any earlier versions.
You can also set your proxy to expire on a specific date or after certain conditions are met. One automatic trigger worth knowing: if you name your spouse as your proxy and later divorce or legally separate, the appointment is canceled automatically in most states. If you still want your former spouse to serve in that role, you’ll need to complete a new form explicitly naming them.