Choosing an agent for end-of-life decisions

What if the patient can't decide on an agent?

Perhaps the person has a very clear idea of what type of life-prolonging or comfort care he would want toward the end of life, but he's hard-pressed to come up with a trusted person to name to supervise that care. In such a case, encourage him to go ahead with expressing his wishes for care in writing in a directive -- even if he has to forgo naming an agent.

While this method isn't optimal, in such a case medical personnel would still be legally bound to follow the written wishes for care -- or find another doctor or hospital willing to carry them out.

On the other hand, the patient may not be sure, right now, exactly what medical procedures he would or would not want to undergo in the future. But he is ready to name an individual to oversee his medical care if he becomes unable to express his wishes -- someone who knows his mind and will lobby for that care even when up against an unwilling medical establishment.

In such a situation, encourage him to take the step of naming the healthcare agent while skipping the other step of setting out detailed wishes for medical care. That will ensure that one specific person will be authorized to supervise his care, rather than leaving medical decisions up to the whims of a particular doctor or hospital policy.

How should someone choose an agent?

First, know the rules. In many states, the patient's doctor can't be named the patient's agent in an advance health care directive. In any case, it's a bad idea to name a doctor. Instead, the patient should select someone trustworthy and loyal who, above all else, knows his wishes and can discuss them with him and with others. This, of course, requires that person's willingness and ability to talk openly with the patient about dying and death.

Ideally, the agent should be someone who can be physically present or easy to reach when the patient needs to have healthcare decisions made. And the agent should have a strong enough personality to make sure that the patient's wishes are followed -- someone who can't be bulldozed by family members or by doctors.

The patient should name only one agent, not two. This avoids disputes. But he should name a successor or alternative agent, particularly if the agent is also elderly -- for example, if a husband chooses his wife as the initial agent. The alternative agent will serve if the first-named agent also becomes incapacitated, dies, or is otherwise unable to serve.

Where should the completed advance health care directive be filed?

Keep the original advance health care directive in a safe place that's easy to find, and give copies to:

• Each of the patient's regular doctors (request that it be made part of his formal medical record).
• The named agent and successor or alternate agent.
• The patient's lawyer (even if the lawyer didn't prepare the document).
• Any healthcare facilities where the patient will be treated.
• Close family members (or close friends, if the person desires).

The patient can also keep a note in his wallet stating that an advance health care directive exists and giving contact information for any agent who's named.