What Is The Difference Between A Health Care Proxy and A Living Will?


Although being able to communicate with a healthcare professional about your treatment or medical care preferences is incredibly important all throughout your life, it’s even more important as people start aging. There are plenty of useful tools for people looking for end-of-life care, with two of the most popular being a living will and a healthcare proxy. There’s also an advanced healthcare directive or medical directive, which usually goes hand-in-hand with the previous two.

These tools are especially important during a time when  the world is learning more about the science and medicine which has really lengthened our lives. But as lives grow longer people tend to experience various health challenges such as terminal illnesses, and sometimes can even find themselves in a position where other people have to make decisions for them during different medical situations. That’s why these tools are so useful, and why it’s a good idea to plan for them in advance.

Health Care Proxy

A healthcare proxy is also known as a “health care surrogate” or “medical power of attorney”, or “health care power of attorney”, and it’s specifically designed for people who want someone else to assume the power to make decisions over their medical treatments or procedures when they are no longer able to make them on their own. With a healthcare proxy, you generally appoint a person in the event that you’re unable to make medical decisions for yourself, to make those decisions for you.

Most of the time, these types of situations happen either because you no longer have the ability to make your own decisions, or because you’re unconscious due to an illness or an injury. Usually, you can appoint one person as your health care proxy, and that  person is commonly a family member or a close friend. However, in some cases and in some US states, you can appoint a second  person, who will be the alternate proxy to your primary healthcare proxy, in the event that your first choice is no longer available to complete their duties. 

However, before appointing anyone as your healthcare proxy you should make sure that they are willing to accept that position. This person should be a good decision-maker who won’t let their own emotions or beliefs get in the way of your wishes regarding your medical choices. That means having a conversation with the person you want to assign as your health care proxy, so you can better understand each other’s positions and figure out if they truly are the best fit for the task.

The healthcare proxy will become effective once a doctor determines that you’re no longer able to make or communicate your own health care wishes and treatment preferences. But before that time comes, you should have already filled out a healthcare proxy form, and should also have discussed your medical choices  for the future with your proxy.

That form will be valid until the point when you revoke it, either by filling out a new healthcare proxy form at a later date or by stating that you want to change your healthcare proxy to a medical professional.

One of the biggest benefits of having a healthcare proxy is that this person will be able to make medical decisions for you based on the most up-to-date and current information, depending on your previous decisions and your current state as well as doctors’ recommendations.

When choosing your health care proxy you should do so carefully and thoughtfully, as this is the person who will be making decisions and acting on your behalf when you’re unable to do so on your own. After you appoint your proxy you should allow them to have access to your medical records, and you should also discuss your wishes about various types of medical care with them. That includes things like resuscitation, hydration, and artificial nutrition, thoughts about the quality of your life, and more. 

Knowing your wishes will help guide your proxy’s decisions and inform your medical team. Additionally, your family and friends will be comforted to know that someone is making decisions based on your own personal values during a stressful time. Having a healthcare proxy also means there won’t be additional miscommunication or debates over your long-term or end-of-life care preferences, as you’ll have already discussed and outlined all of them with the person you appointed.

Living Will

A living will is a document that allows you to specify all the types of future medical care or treatments you do or don’t want , should you ever become unable to communicate this on your own due to a future  injury or illness . There are plenty of different types of treatments that people include in their living wills, such as artificial nutrition, medical ventilator, resuscitation, and other end-of-life decisions.

Although you might not be able to predict every single variable that will affect your family’s future decisions about your healthcare choices, you should take care in describing your wishes in detail in your living will. Before finalizing your living will and your wishes, you can always talk to a healthcare provider or your physician, and discuss what is and isn’t possible for your goals with your medical situation, or simply have them explain medical terms you’re not familiar with.

One of the disadvantages of a living will is that although you might spell out your exact instructions in writing in the document, different people may interpret your instructions differently. For example, what you believe long-term care entails might not align with what your family thinks or believes, which can lead to misinterpretation of your living will. Additionally, there is no reliable way right now to create a living will that will cover all potential medical situations or perspectives.

Most living will documents generally tend to cover certain types of procedures that can be performed when you become incapacitated or arrive at the end of your life, such as the ones below.

Artificial nutrition

If the patient is no longer able to swallow anything, with this procedure the doctors can supply fluids and nutrients through a tube that’s inserted through the nose into the stomach or into a vein when the gut isn’t working well. If the patient is in a situation where they are likely to recover, tube feeding is common. Hydration is also a temporary solution that can be used both long and short-term, where the patient receives a solution of water, sugar, and minerals.

Mechanical ventilation

With this procedure, a ventilator, respirator, or even a breathing machine will be forcing air into the patient’s lungs when they’re not able to breathe on their own. A tube will be attached to a machine and inserted into the patient’s mouth, nose, or throat to pass air into their lungs. People who require ventilators are not fully conscious as this is a very uncomfortable position. It’s similar to tube feeding, as it can be used for a short or a longer period of time, and can be used during the recovery process.

Cardiopulmonary resuscitation (CPR)

When a patient’s heart or breathing stops and they become unconscious, they can be resuscitated by CPR. This is a technique that involves artificial circulation respiration, and defibrillation to restart either the heart or breathing. If this technique fails, the next step in resuscitation is advanced cardiac life support, where the patient gets intubated and put on mechanical ventilation, while also receiving medication that controls the heart rate, blood pressure, and kidney function. While CPR can cause injury in some cases the revival rate is rather low.

Advance Healthcare Directives

While both the health care proxy and the living wills are tools that are incredibly useful for many people, an advance directive is a legal document that outlines healthcare directives in advance and can make difficult choices a lot easier for the friends and loved ones of a patient. This is where the advanced healthcare directive comes in, where you can detail the healthcare decisions regarding treatments or procedures you’d like to receive, and make things easier for your friends and family, or even your health care proxy.

In these documents, it’s important to define all of the procedures or treatments you’re looking to get, as well as those that you don’t want and your opinion and beliefs about your quality of life when you become incapacitated. That’s the only way that your family and friends, or your healthcare proxy will be able to make strong decisions, even during changing or unfamiliar situations. You can include your advance healthcare directive with your healthcare proxy form, or with your living will, as this document can help guide future medical decisions when you demonstrate  incapacity.

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FAQs about Healthcare Proxies and Living Wills

Are living wills available everywhere in the US?

While living wills are incredibly useful documents and end-of-life care tools, they’re not legally available in every state, and you should check your local regulations or get legal advice before making one of these documents.

Can I have both a living will and a healthcare proxy?

You can always choose to have both documents,in which case your living will is going to be a supplemental guide to your healthcare proxy’s decisions, aside from the advance healthcare directives.

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