Healthcare Proxy vs. Power of Attorney: What Each Document Does

"Power of attorney" can be a confusing phrase, because it can describe more than one kind of document. A durable power of attorney for health care lets someone you trust make decisions about your medical care. A power of attorney for financial or personal affairs is a separate role. Knowing which is which helps you put the right document in place.

This guide explains the difference in plain language, how a living will fits in, and how to think about choosing the person you name. It is general information, not legal or medical advice. Rules vary by state, so confirm the details where you live.

The quick comparison

What is a health care proxy?

A health care proxy is a legal document in which you name a person, often called a health care agent, to make health care decisions for you if you are unable to make them yourself. MedlinePlus, the consumer health service of the U.S. National Library of Medicine, explains that this person acts only when you cannot.

The same idea goes by several names. The National Cancer Institute describes a "durable power of attorney for health care" as the document that lets you name another person to make decisions about your medical care, and notes it is also called a health care proxy or a medical power of attorney for health care. The person you choose may be called a health care agent, surrogate or proxy.

Why have one? MedlinePlus points out that family members may be unsure or may disagree about the care you would want. Decisions about your care may then be made by providers, hospital administrators, a court-appointed guardian or a judge. An agent you picked yourself can help your providers and loved ones during a stressful time. The agent's duty is to see that your wishes are followed, and if your wishes are not known, to try to decide what you would want.

Health care agents are not required, but MedlinePlus calls them the best way to be sure your wishes for treatment are followed.

What is a financial power of attorney?

A power of attorney in the financial sense lets a person you choose manage money and personal affairs. MedlinePlus is explicit that a health care agent "has no control over your money" and cannot be made to pay your bills, and that you would need to choose a power of attorney to manage financial or personal affairs if you cannot. MedlinePlus also says a special health care power of attorney does not give anyone the power to make legal or financial decisions for you.

That is the key distinction: a health care agent and a financial power of attorney are two separate roles.

Where a living will fits

A living will is the third piece, and it works differently. According to MedlinePlus, a living will explains the care you do or do not want, such as:

• CPR if your heart stops beating or you stop breathing
• Feeding through a tube
• Long-term care on a breathing machine
• Tests, medicines or surgery
• Blood transfusions

Two limits are worth knowing. A living will does not deal with financial issues, and it is not the same as a last will and testament, which takes effect after death. And you cannot name someone to make decisions for you in a living will. That is the job of the health care proxy.

MedlinePlus describes advance directives as legal documents that let you spell out your decisions about end-of-life care ahead of time. A living will and a durable power of attorney for health care, the document that names your health care proxy, are both types. They do different jobs: the living will states the care you want, and the health care proxy is the person who can make health care decisions for you when you cannot.

If you have not written down your treatment wishes in an advance care directive such as a living will, MedlinePlus notes that a health care agent will be the one to help your providers make important choices. If you do have one, your agent can make sure your wishes are followed, and the agent's choices come before anyone else's wishes for you.

What can a health care agent do?

This varies by state, so check the laws where you live. MedlinePlus says that in most states a health care agent can:

• Accept or turn down medical treatment for you, including life-sustaining treatment
• Consent to a treatment and later stop it if it is not helping or is causing problems
• See your medical records and release them
• Ask for an autopsy and make an organ donation, unless your advance directive says otherwise

Before you pick an agent, MedlinePlus says to find out what your state allows, for example whether an agent may refuse or withdraw life-enhancing care, or refuse or stop tube feeding or other life-sustaining care, without it being stated in your advance directive.

Who can be your health care agent?

According to MedlinePlus, choose a person who knows your treatment wishes and is willing to carry them out. Your agent should be:

• An adult, age 18 or older
• Someone you trust and can talk to about the care you want
• Someone who supports your treatment choices
• Someone likely to be available if a health crisis happens

The person can be a relative, a close friend, or a minister, priest or rabbi. Name only one person as the agent, and one or two backups in case your first choice cannot be reached when needed. In many states, your agent cannot be your health care provider or an employee of the hospital, nursing home or hospice program where you receive care, even if that person is a trusted relative.

MedlinePlus advises talking to each person you are thinking of naming as your agent or alternate.

How to put the documents in place

MedlinePlus and the National Cancer Institute describe these steps:

1. Think about your values. Consider the quality of life you value. MedlinePlus describes life-sustaining treatments as treatments that may extend your life but do not cure your illness, such as ventilators and dialysis.
2. Talk with your people. Discuss your wishes with family members, your chosen agent and your providers. The National Cancer Institute notes that doing so means your wishes are known, can comfort family members and can give you peace of mind.
3. Get the form. A health care proxy form is available online, at a provider's office, a hospital or a senior center.
4. Complete it according to your state's rules. Many states require witness signatures. The National Cancer Institute notes that a living will or durable power of attorney accepted in one state may not be accepted in another. The National Cancer Institute suggests reviewing the documents with your doctor or care team for accuracy before signing.
5. Share copies. The National Cancer Institute suggests giving copies to your doctor, hospital and family, storing copies in a safe place that is easy to access, and keeping a wallet card saying that you have these documents and where they are.
6. Review them. You can change your mind at any time. If you do, tell your agent and your provider. The National Cancer Institute also suggests destroying old versions when you sign new ones.

When to do it

The National Cancer Institute says all adults should have advance directives and that it is best to complete them while you are healthy, in case you later become ill or unable to make decisions.

Key takeaways

• A health care proxy covers health care decisions and gives no control over your money. A financial power of attorney covers financial or personal affairs. They are separate roles.
• A living will states the care you want, and a health care proxy names who speaks for you.
• Choose an adult you trust, name backups, and talk with them before signing.
• Rules on witnesses, who can serve and what an agent can do vary by state, so confirm local requirements.
• You can change your mind at any time. Tell your agent and your provider about any changes.

This article offers general information and is not legal or medical advice. For help preparing documents that follow your state's laws, MedlinePlus suggests your attorney, provider, hospital or a community social worker.

Sources

• MedlinePlus Medical Encyclopedia: Health care agents. https://medlineplus.gov/ency/patientinstructions/000469.htm
• MedlinePlus Medical Encyclopedia: Advance care directives. https://medlineplus.gov/ency/patientinstructions/000472.htm
• MedlinePlus: Advance Directives (topic page). https://medlineplus.gov/advancedirectives.html
• MedlinePlus Medical Encyclopedia: Deciding about treatments that prolong life. https://medlineplus.gov/ency/patientinstructions/000468.htm
• National Cancer Institute: Advance Directives. https://www.cancer.gov/about-cancer/managing-care/advance-directives