Expert Advice: What to consider before agreeing to be someone's health care proxy

Host Amber Smith: Here's some expert advice from bioethicist, Dr. Syd Johnson from Upstate Medical University.

What should someone consider before agreeing to serve as a healthcare proxy?

Syd Johnson, PhD: The proxy or the surrogate's job is to make decisions that the patient would make for themselves. And that's based on their understanding of what was important to that patient. It might be based on conversations that they had with the patient, or their knowledge of the patient, or the values and interests that they shared with that patient. For patients who've also left some kind of advanced directive, the surrogate also has to honor that advanced directive. If that person knows the patient well and understands their values, their religious beliefs, if they had any, and has talked to them about their preferences and their wishes, then they can make decisions that are probably pretty close to what the patient would decide for themselves.

I think every adult should have a healthcare proxy. And that proxy can be anyone that you think is able to represent you in making medical decisions. If you are a healthcare proxy, then you want to do your best to make decisions consistent with the wishes and preferences and values of the person that you're representing. If you can't do that, if for example, you have religious or moral objections to something that the patient would want, then you should bow out and let that patient know that.

How well you know that patient, how well you understand what they want, whether or not they would want treatment continued, what kind of treatment they would want, do they want everything possible done to keep them alive for as long as possible, or would they want you to end treatment at some point, even if it means that they won't survive? Those are all difficult questions to talk about with people. But they're questions that the proxy or the surrogate really needs to know. Are there specific kinds of treatment that the patient does or does not want, like feeding tubes or ventilator or surgeries? Would they want hospice care at the end of life? These require really difficult discussions, and no one ever anticipates all the things that might happen or go wrong for them. So, fundamentally, the proxy really has to be able to put themselves into the patient's shoes, so to speak, and decide as that person would decide at the point at which decisions need to be made.

Host Amber Smith: You've been listening to bioethicist, Dr. Syd Johnson from Upstate Medical University.