Health Care Surrogates and Living Wills 

Most people do not like to think about dying, but the sooner you consider the practicalities of health care for the end of your life, the more you can arrange to receive the care you want.

By appointing a surrogate, the person can make serious decisions on your behalf. Having a living will allows you to specify the types of care you want.

Although surrogates and living wills are mostly used in end-of-life situations, they can also be important for younger people who have unexpected serious health problems. If you have an accident that leaves you unconscious for a long period, for example, you will not be able to express your wishes. By being prepared, you can have peace of mind that your wishes will be carried out. You will also be taking the burden off your loved ones’ shoulders, as without a surrogate or living will, it will usually be your family making the decisions.

What are health care surrogates?

Health care surrogates are adults who have been appointed to make decisions about your health care when you become too ill to make the decisions yourself. You authorize the chosen person to be a surrogate through the Designation of Health Care Surrogate form. It is best to select someone to be your surrogate before you fall too ill. That way, you can discuss your health care with your surrogate so the person knows what your exact wishes are. However, if you are too unwell to appoint a surrogate, and have not already appointed one, a doctor or other health care professional will appoint a surrogate for you. The appointed health care surrogate is legally required to make any health care decisions for you.

The health care surrogate will have access to your medical records so he or she can make appropriate decisions regarding your health care. These decisions include:

  • Should you be placed in a nursing home?
  • Should your life support system be turned off?
  • Should you apply for Medicaid if you are not enrolled?
  • Would a course of action compromise your moral or religious beliefs?
  • Should your organs be donated?
  • Should an autopsy be allowed?

Who is allowed to be a health care surrogate?

Any adult over the age of 18 who is deemed competent can be a health care surrogate. If you are choosing a surrogate yourself, you need to ask the person you would like to act as your surrogate if he or she is willing to act on your behalf. It is a good idea to also select a second person in case your first choice is not in a position to act as a surrogate when the time comes. If you decide to appoint your husband or wife to be your surrogate and you then divorce, that person’s surrogate position will be revoked unless you state otherwise in your advance directive or living will.

If you are incapacitated and you have not chosen a surrogate, one will be selected for you according to a prioritized list. The hierarchy of selection, beginning with the first person to be considered, is as follows:

  • Spouse
  • Adult children
  • Parents
  • Adult siblings
  • Adult grandchildren
  • Friends

The doctor making the selection process will use that list along with other criteria to choose whom he or she thinks would be the best-qualified person.

What are living wills?

Living wills detail your choices for end-of-life care. It specifies the type of health care you do or do not want in case you are unable to communicate your wishes yourself when you become unwell.

The most common issue involves whether you want life-sustaining measures to be employed when you have a terminal illness, disease or condition. Other specifications of living wills can include your choices regarding:

  • The use of antibiotics.
  • The use of pain relief.
  • The use of ventilators.
  • The use of cardiopulmonary resuscitation.
  • The use of blood products.
  • Feeding.
  • Hydration.

Living wills are typically consulted when you are terminally ill, in a coma, severely injured, have dementia or in the last stage of your life. By making a living will before you become unwell, you are also easing the burden of decision-making that would otherwise have to be made by your loved ones during a time of crisis. Living wills are not only for seniors. Unexpected serious health care issues can arise at any time of life, so it is best to be prepared. Before you make a living will, talk it through with your doctor and your family and friends.

What should you include in a living will?

As well as making choices about life support machines and organ donations, there are plenty of other health care measures you need to consider. Think about any problems that could potentially arise, so you can include them in your living will. You can talk to health care professionals about what to be prepared for. Here are some common health care considerations regarding end-of-life care you need to think about:

  • Would you rather die at home than in a hospital or nursing home?
  • Would you want to be placed on a mechanical ventilator when you are unable to breathe by yourself? If you would, then how long would you want the ventilator to run for?
  • Would you want to be resuscitated by cardiopulmonary resuscitation after your heart has stopped beating?
  • Would you want to receive antiviral medicine and antibiotics to treat infections?
  • Would you want to be tube fed? This is when you receive fluids and nutrients intravenously.
  • If your kidneys are not functioning, would you want to have dialysis? Dialysis removes waste from your blood and manages fluid levels.

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