How to Write Your Own Health Care Proxy

A health care proxy lists your wishes for medical treatment should you ever become unable to make those decisions yourself. It can also name the person whom you designate to make decisions for you.

Difficulty:

Moderate

Instructions

1. Understand that most states permit you to have a health care proxy. This is also sometimes called a directive or power of attorney.

2. Know that the law is different in each state; you should check with an attorney or online law source for specifics in your state. However, the document described here will be acceptable in most situations.

3. Realize that your doctor will be bound by the directions you give in your proxy.

4. Create your health care proxy by typing a document in which you state that it is a health care proxy or directive and that your intention is to give directions to your doctors should you become incapacitated or comatose.

5. Note that in some states you may only give directions for what is to happen if you are terminally ill and comatose.

6. Describe situations in which you want your health care proxy to take effect. For example, "This is to take effect if I am terminally ill or injured, comatose with little hope of recovery, or in a vegetative state" is one way to describe your wishes. Make sure you make your health care proxy personal to your wishes.

7. List treatments you do not consent to. Many people include things such as the use of a respirator, resuscitation, blood or blood products, life-sustaining medications, and even food and water. You can also list nothing and instead state that you want the person you have designated to make the decisions at the time.

8. Name the person you wish to have the authority to make decisions for you. You do not need to name someone, but be aware that if you do not, doctors will take directions from your closest family members and will not discuss matters with partners or friends. You can also list an alternate, should the person you choose be unavailable or unable to make decisions.

9. State that you are authorizing this person (list the person's full name, address and phone number) to make medical decisions for you should you be unable to.

10. Discuss your wishes with that person and state in the document that you have done so.

11. Mention that you are aware of the decisions you are making and do so with complete understanding.

12. Sign the document in front of a notary and two witnesses.

13. Keep the document in a safe place. You may wish to give a copy to your doctor to keep on file. Some people like to carry this document in their purses or wallets.

Tips & Warnings

• Should you need assistance preparing this document, many terminal illness organizations such as cancer and AIDS support groups, hospices, and hospitals can provide you with appropriate forms.

• You can destroy your health care proxy any time you choose and completely revoke all decisions in it.

• Do not execute this document unless you are certain about all of the decisions you have made in it.