What It Involves

In New York State, if you are age 18 or older, the advance directive to complete is the Health Care Proxy (HCP). The New York State form has easy-to-follow directions and answers to some common questions.

The purpose of the health care proxy is for you to appoint someone (the “health care agent”) who can represent you in case you are unable to make medical decisions for yourself (do not have “capacity” as determined by a doctor). You can also appoint an alternate agent. Only one person can act as your agent at any one time. The alternate agent is called if your primary health care agent is unable to serve.

A medical provider may declare that someone does not have capacity to make medical decisions for himself or herself if the person is unconscious, has had a major stroke, has advanced dementia, or is otherwise not able to understand the decisions and consequences at hand.

Your health care agent has the authority to make decisions regarding your health care related to life support and medical treatments, unless you write out different instructions on the health care proxy form. If you want your agent to make decisions about artificial nutrition and hydration (nourishment and fluids by feeding tube and intravenous [IV] line), you need to specify this in item #4 on the health care proxy form by writing: “My agent and alternate agent know my wishes about artificial nutrition and hydration.”

The health care proxy form needs to be signed by two witnesses who are age 18 or older (and cannot be the health care agent or alternate agent listed on the form). When you have completed your form, make several copies. Keep one in a safe place at home. Give one copy each to your health care agent, alternate agent, physicians, family members, and any others who may be involved in your care. Go over the document with each person who gets a copy and discuss your choices.

To make your health care proxy as valuable and efficient as possible in case of an unexpected serious medical issue or at the end of life, it is important to have ongoing conversations about your choices with your family and physicians.

Do you also need a Living Will? A Living Will:

Choosing your health care agent is important, so that someone you trust can speak for you if you cannot make medical decisions for yourself. Choosing a health care agent requires some thought.

Most people choose a family member or close friend. Choose someone 18 years or older who knows you well. You cannot choose someone who provides medical care for you. You need to choose someone you trust to carry out your wishes even if the decisions become difficult. Often the best agent is not the person closest to you.

When you discuss your choices for medical care with your health care agent, include various situations that may come up and explain what you would want. Be sure to ask if he or she is willing to act on your behalf in these situations.

In New York State you appoint one primary agent and one alternate agent. The alternate agent is a backup in case the primary agent is unable to serve.

When you make your choice, you may want to think about:

If you need help choosing your health care agent, please contact us. 

If you choose an agent who is not a family member, tell your immediate family members who you have chosen and why. It is important that your family and your medical team know who legally speaks for you. If you have conversations with all the people who are important to you and tell them what your choices are, there is less risk of conflict.

Your agent cannot be sued for health care decisions made in good faith.

Thinking about your life and what matters to you is often a good starting point for thinking about how you would like to live if you were seriously ill or at the end of life and unable to speak for yourself. You can begin by thinking about how you would finish sentences such as:

As you are deciding about your care preferences, have conversations with your family and health care agent and let them know about your choices. Starting the conversation is not always easy. Some people simply begin with, “I have been thinking about how life ended for [a friend, relative, a person in the news] and I want you to know what I would want in that situation.” 

Talk about what you want in general as well as what you would want in different situations. All possible situations cannot be covered, but your examples will give your family and health care agent a good sense of your goals of care and an idea what good end-of-life care means to you. 

Keep having these conversations. The more you talk about your wishes for end of life care, the more it will become clear to your family and health care agent what is really important to you.

Helpful tools for starting the conversation and moving it along:

Print version of Helpful Conversation Tools

Conversations with your physician about your care choices can start at any time, regardless of your health status. You can begin the discussion when you give him or her a copy of your health care proxy. Your physician should always have a copy of your advance directive.

Make clear the kind of care you would want if you have a serious illness or unexpected event from which you might not fully recover (for example, a massive stroke, a major heart attack, or a serious brain injury). You may want to discuss if certain procedures are likely to lead to recovery or prolong the process of dying.

Ask your physician’s advice about the need and timing of more in-depth discussions or more detailed advance directives. This discussion may be appropriate if you are elderly and want to define your preferences for care in more detail even if you do not currently have a serious illness. It is always a good idea to tell your doctor about your end-of-life choices.

When you have appointed a health care agent, or if you make a change in your health care proxy, make sure you tell your physician and give him or her the new copy.

Learn more about having the conversation with your physician.