Health Care Proxy vs. Living Will

A health care proxy and a living will are both forms of advance directives – ways to communicate how medical decisions should be made if you cannot make your own decisions.

What is a health care proxy?

A health care proxy (also referred to as a durable power of attorney for health care) is a document that appoints someone to make medical decisions for you, if you are in a situation where you can’t make them yourself.

You must choose your proxy thoughtfully since he/she will be acting on your behalf. After appointing your proxy it is extremely important to discuss your wishes with them about your medical care, including resuscitation, artificial nutrition and hydration and personal goals for quality of life. Knowledge of your wishes will help guide the decisions your proxy will have to make with your medical team. Knowing that any decisions made are based on your personal values and wishes will be a comfort to family and friends during a stressful time.

What is a living will?

A living will is a document that specifies what type of medical treatments you would or would not want if you were unable to communicate. These treatments may include resuscitation, artificial nutrition and hydration and mechanical ventilation.

Living wills are usually too narrow to apply to many common medical situations. They often use language such as “incurable or irreversible condition with no reasonable expectation of recovery.” It’s very rare that a person faces this specific situation. More often a person is faced with a small chance of recovery, but not zero; or the person may be able to “recover” but not to the same level of health.

Be aware that there are differences in the legal status of living wills in each state. For example, in New York State a living will is actually not a legal document and medical decisions may not be based on it alone.

What should you do?

Everyone should consider doing a health care proxy because the person you designate will be able to make judgments based on the most current situation and information. Naming a proxy early will help you prepare for the unexpected.

A living will is one way to communicate your values and beliefs, but language used in standard living wills is usually too narrow to be useful in many common medical situations.

Gabrielle Goldberg, MD is Education Director of The Lilian and Benjamin Hertzberg Palliative Care Institute at Mount Sinai School of Medicine in New York City.