Part 1 of Anne’s post focused on the 5 strategies of an effective healthcare directive. This week’s post shares insights regarding the selection of healthcare agent(s).
Well-written healthcare directives require more than checking boxes on a perfunctory form. Clear treatment guidelines can provide meaningful support to decision-makers, reduce the risk of family conflict, and ease the emotional stress and guilt that healthcare agents often experience. Preparing loved ones through open family conversation is also essential.
Unfortunately, too few agents are chosen based on their ability or willingness to serve in this vital role. Rather, healthcare agents are most often chosen based on convention. The spouse is assumed to be the decision-maker. However, honoring the wishes of the patient can be diametrically opposed to a husband’s desire to extend his wife’s life, or vice versa. In some cases, the spouse might succumb to emotional distress and request “all possible care” in spite of the patient’s expressed wishes otherwise. Absent the spouse, the eldest son is often selected. In still other cases, an aging parent might assume her children will agree upon her care. However, for most siblings, unanimous agreement on life or death decisions for a parent can be difficult to achieve.
Speaking on behalf of clients everywhere, I emphatically encourage attorneys and other trusted advisors to proactively coach your clients regarding their selection of healthcare agents.
Your clients will be empowered to make the wisest selection of healthcare agents and/or to serve as an agent when you teach them:
- The responsibilities of the healthcare agent. When the depth and breadth of this role is understood, your clients will be better able to choose healthcare agents wisely. To serve effectively, a healthcare agent needs to:
- Fully understand the care preferences of the principle. The agent should press for clarity that goes beyond glib responses such as “no heroic measures.” Exploring various possible scenarios can help the principle to express his or her wishes with greater clarity and detail.
- Become familiar with the principle’s health concerns. This can provide critical information that might impact future decision-making.
- Anticipate family dynamics. Most agents will navigate through challenging family dynamics. Proactively recognizing the likely conflict with and between emotionally distraught loved ones is wise preparation.
- Understand the legal boundaries and authority of this role. If conflict with medical professionals or loved ones arises, an agent must know and confidently utilize the legal authority of the healthcare agent role.
- The characteristics of a well-chosen agent. A well-chosen agent will be willing to zealously advocate for the principle’s end-of-life preferences. Necessary traits include:
- Strength of character. Passive or highly emotional loved ones might be ill equipped to represent the patient’s wishes.
- The agent must advocate for the principle’s preferences above his own emotional needs.
- Most agents will confront the emotional peril of family dynamics and/or the persuasion of medical staff to pursue unwanted treatment. Emotional stamina is imperative.
- The agent needs to be available and accessible to respond in a crisis.
- How to prepare to serve as a healthcare agent. For those of your clients who have already been appointed as the healthcare agent for a loved one, you can offer suggestions on how best to prepare for the role as well as provide questions to ask the principle. For example:
- Will other agents be involved?
- Who has final decision-making authority?
- How do I secure online access to and/or a paper copy of the healthcare directive document?
- What exactly do you mean when you say …?
Optimally, the agent should encourage the principle to gather loved ones and agents together for a family meeting where end-of-life decisions are openly discussed.
As trusted advisors, you can influence your client’s selection of healthcare agent. Even further, you can promote proactive family communication by offering to facilitate a meeting with adult children and the chosen healthcare agent(s). Hint: With complex or blended families, incorporating the expertise of a social worker or family therapist might be helpful.
What a privilege. With your guidance and assistance in crafting an effective healthcare directive, your clients—and their loved ones—will have peace of mind.