Getting Started with an Advance Care Plan

What am I getting with MyDirectives advance care planning for AARP Medicare Supplement members insured by UnitedHealthcare?

How My Advance Care Plan Works

Security, Accessibility, and Legality

Choosing a Healthcare Advocate

A healthcare advocate is the person chosen by a patient to make healthcare decisions in the event that the patient cannot make decisions for him/herself. It is sometimes called a healthcare proxy, substitute decision-maker or healthcare agent, depending on the state.  States have different requirements for appointing a healthcare advocate.  In this tool the term is used generally, but is not intended to encompass a legal power of attorney or other similar representative.  If you have questions talk to an attorney or your legal advisor.

In most cases, your healthcare advocate can be anyone that the law in your country or state considers to be an adult, but with these exceptions:

  • Your healthcare advocate can't be your treating doctor or the doctor's staff (to prevent potential conflicts of interest, some states say no medical treatment providers can be a healthcare advocate).
  • Your healthcare advocate can't be the owner/operator or employees of the medical facility, nursing home, or hospice where you're being treated unless you're related by blood, marriage, or adoption.

You don’t have to choose a healthcare advocate, but it may help ensure that doctors and providers know your healthcare wishes in the event you cannot speak for yourself.

Generally, your healthcare advocate can speak on your behalf regarding medical treatment decisions if you're too sick or injured to make or communicate your wishes yourself.  It is important to let your healthcare advocate know what you think makes life worth living and how much medical intervention is acceptable to you.

Before you choose your healthcare advocate, it's a good idea to make sure the person agrees to take on the responsibility. If you change your mind later, you can remove this person and update your advance care plan with a new healthcare advocate at any time. Even if you have a healthcare advocate, you still have control over your medical decisions unless, and until, typically either doctors decide that you've lost your ability to make and communicate medical decisions for yourself, or a court declares you to be incompetent.

If you choose to have a healthcare advocate, you can select the kinds of decisions you want your healthcare advocate to be able to make on your behalf.  You can choose to limit or expand your advocate’s authority to a specific period of time (days, weeks, or months) and to specific medical treatments. The tool provides a list of typical responsibilities. 

Consult your attorney or legal advisor with any questions, including about general versus specific authority. 

A healthcare advocate can help make sure your providers know about your treatment preferences that go along with your values, beliefs, and wishes.

Choosing your healthcare advocate is an important decision. The tool lets you choose one person to be your primary healthcare advocate, and you can make the other one or two people your alternates in case your first choice is unavailable in an emergency.

Before you choose your healthcare advocate, it's important to think about a couple of things:

  • Can this person be at the hospital to assess the situation firsthand and talk with your doctors?
  • Can this person handle the pressure of potentially very hard decisions during a time of great stress?

The tool also provides you with additional characteristics to consider when choosing an advocate.

You should speak with anyone you're considering to be your healthcare advocate to make sure that the person is comfortable with the responsibility. You also need to talk about your goals, preferences and priorities in cases of emergency or critical care, advanced illness, or end-of-life situations. You may also want to discuss your thoughts about quality of life, so that the person you choose to be your healthcare advocate will know how you'd like medical treatment decisions made on your behalf.

Once you're clear about who you would like to choose, just enter the name and contact information in the appropriate boxes. Or if you have previously entered this person in your list of personal contacts in your My Circle section, simply click on the person's name in the contact box that pops up.

It's important to talk to your healthcare advocate about your advance care plan, so they know what’s important to you if you are in a situation where you can’t speak for yourself.

When you choose your healthcare advocate, you can limit that person's authority to a specific period of time (days, weeks, or months). You might choose to do this if, for example, you know your healthcare advocate will be moving in the future or will become unavailable for some reason. You can also limit their authority to specific medical treatment decisions. The tool walks you through these options.

Even if you have a healthcare advocate, you still have complete control over all of your healthcare decisions unless, and until, doctors decide you can't make or communicate decisions for yourself, or a court declares you to be incompetent.

You should know that your healthcare advocate has no power over decisions that aren't related to medical treatment, such as finances, work-related issues, funeral matters, and anything that might be covered in your will.

A healthcare advocate typically becomes active if you lose the ability to understand the medical problem and the risks and benefits of medical treatment choices. Put another way, if you lose the ability to make and communicate choices that show you understand and appreciate the decisions being made and their possible consequences, or if a court declares that you are incompetent, then the healthcare advocate steps in. You often hear the term "incapacitated."  In medical situations, if you become incapacitated, that means doctors have determined that you have become unfit or unable to make and communicate medical treatment decisions, and the healthcare advocate will need to decide on your behalf.

If you are competent and can make and communicate medical treatment decisions, your current wishes take priority over both your healthcare advocate's wishes and any written or recorded expressions of your medical treatment goals, preferences and priorities.  Talk to your legal advisor about the role of a healthcare advocate.

If your healthcare advocate can't be reached when needed, it's important to have alternates – talk to your legal advisor about what may happen if your healthcare advocate or alternates cannot be reached.

Alternate healthcare advocates aren't required, but it's a good idea to have one or two alternates ready in case your first choice cannot be reached or act in an emergency.  Talk to your legal advisor about what may happen if your healthcare advocate or alternates cannot be reached.