A Guide to Choosing Your Healthcare Agent

A healthcare agent — also called a healthcare proxy, medical power of attorney, or healthcare surrogate — is the person you designate to make medical decisions on your behalf if you become unable to make them yourself. This is arguably the most important decision in your entire advance care planning process. Your living will provides written instructions, but no document can anticipate every possible medical situation. Your healthcare agent fills the gaps, interpreting your values and preferences in real-time when circumstances arise that your living will does not specifically address.

What a healthcare agent actually does

The role of a healthcare agent goes beyond simply presenting your living will to doctors. Your agent may need to:

• Communicate with your medical team about your condition, prognosis, and treatment options
• Make decisions about treatments your living will does not specifically address
• Authorize or refuse tests, procedures, medications, and surgeries
• Decide whether to transfer you to a different facility
• Advocate for your wishes even when other family members disagree
• Make decisions about organ donation (depending on your state and your living will)
• Request a second medical opinion
• Access your medical records

Your agent’s authority typically activates only when your physician determines that you are unable to make decisions for yourself — either due to unconsciousness, severe cognitive impairment, or another condition that prevents you from understanding and communicating.

Qualities to look for

Choosing a healthcare agent is not about picking your closest relative or your best friend. It is about finding someone who has the right combination of personal qualities for a role that can be extraordinarily demanding. Here are the key qualities to consider:

• Willingness to honor your wishes — even if they disagree. This is the single most important quality. Your agent must be able to set aside their own preferences and make the decisions you would make. Ask directly: “If I wanted something you strongly disagreed with, could you still carry it out?”
• Emotional resilience under pressure. End-of-life decisions happen in high-stress, high-emotion environments. Your agent needs to be able to think clearly and communicate effectively while dealing with their own grief and fear.
• Assertiveness. Your agent may need to stand firm against pressure from doctors, hospital administrators, or other family members. A people-pleaser who avoids conflict may struggle in this role.
• Availability. Your agent needs to be geographically and practically available to respond to a medical crisis. Someone who travels frequently, lives far away, or has responsibilities that would prevent them from being present may not be the right choice.
• Medical literacy. Your agent does not need to be a healthcare professional, but they should be comfortable asking questions, understanding basic medical information, and navigating a hospital environment.
• Trustworthiness. You are giving this person significant power over your care and, potentially, your life. You need to trust them completely.

Who not to choose

Some people who love you deeply may not be the right fit for this role. Consider avoiding:

• Someone who cannot handle emotional conversations. If the person becomes visibly distressed or shuts down when you try to discuss your end-of-life wishes, they may not be able to function in this role when it matters most.
• Someone who would prioritize their own feelings over your wishes. A family member who says “I could never let them stop treatment — I am not ready to lose you” is telling you their decisions will be based on their needs, not yours.
• Your physician. Most states prohibit your treating physician from serving as your healthcare agent due to the conflict of interest.
• Someone with a financial interest in your death or survival. This includes anyone who would inherit significantly based on the timing of your death, if that interest might bias their decisions.

Preparing your agent for the role

Choosing a healthcare agent is only the first step. Preparing them is equally important. Here is how to set your agent up for success:

1. Share your living will and explain your reasoning. Walk through each preference and explain not just what you chose, but why. Understanding your values helps your agent make decisions in situations your living will does not cover.
2. Discuss specific scenarios. Talk through hypothetical situations: “What if I have a stroke and cannot communicate but can still recognize you? What if I have advanced dementia? What if I am in a coma with a small chance of recovery?”
3. Introduce them to your physician. If possible, bring your healthcare agent to a medical appointment. This establishes a relationship and ensures your doctor knows who to contact.
4. Give them copies of your documents. Your agent should have copies of your living will, your healthcare power of attorney designation, and your insurance information.
5. Revisit the conversation periodically. Your preferences may change. Check in with your agent at least once a year to confirm that your documents still reflect your wishes.

Naming an alternate

Always designate an alternate healthcare agent in case your primary agent is unavailable, incapacitated, or unable to serve when the time comes. Your alternate should be someone who also meets the criteria above and who has also had conversations with you about your wishes.

Without an alternate, your state’s default hierarchy kicks in if your primary agent cannot serve — and that may not align with your preferences.

Having the ask conversation

Asking someone to be your healthcare agent is a significant request. Approach it thoughtfully:

• Have the conversation in person, in a calm setting
• Explain what the role involves — do not minimize the responsibility
• Give them time to think about it — do not pressure an immediate answer
• Assure them that you will provide clear guidance through your living will
• Make it clear that saying no is completely acceptable

A reluctant agent is not a good agent. You want someone who accepts the role with their eyes open, understanding both the responsibility and the importance of what you are asking.