Choice of Health Care 'Proxy' Often Surprising

A third of married people would choose someone other than spouse to decide their care, study found

MONDAY, Aug. 21, 2006 (HealthDay News) -- When your health declines so badly that you can no longer speak for yourself and choose your care, who should speak for you?

Ideally, experts say, that's when a legally designated health-care "proxy" would take over. But, according to a new study, the choice of a proxy is often unexpected.

For example, a full third of married individuals said they would choose someone other than their spouse as their proxy, the study found. And female relatives -- such as a mother, a sister or a daughter -- are more likely to be chosen for the role than male relations.

Regardless of who is chosen, "every competent adult should name someone as their agent for health care," said study author Dr. K. Michael Lipkin, an assistant professor of clinical preventive medicine with the department of preventive medicine in the Feinberg School of Medicine at Northwestern University in Chicago.

Otherwise known as a "durable power of attorney for health care", a proxy is a patient-selected adult -- be it relative or friend -- who acts as the decision-maker for all health concerns if and when the patient becomes incapacitated.

"It's like insurance," Lipkin added. "You hope you never need it, and it's likely that only 5 percent of the population is going to get into the kind of crazy trouble that would require it, but that's exactly the point -- it's for the unexpected."

The study was published in the August 2006 issue of the Journal of General Internal Medicine.

In most states, in lieu of a designated proxy, power over health care decisions is automatically granted to spouses or parents if an individual becomes incapacitated.

For many Americans, these "default" choices for proxy may not be the best for them.

In the study, conducted for a six-week period in 1997, Lipkin interviewed 298 adult outpatients between the ages of 19 and 96, in various states of health, all of whom were patients at the General Eye Clinic at the University of Chicago.

These men and women were asked who they would want their doctor to notify in case of an emergency and who they would choose to represent them to execute decisions and deal with doctors if they were too sick to do so themselves.

Over half of the patients also completed a 12-question interview to ascertain attitudes toward choosing a health care proxy.

Among the findings:

  • 100 percent of patients could identify a single individual to be their health proxy.
  • 28 percent chose someone other than their emergency contact to serve as their proxy.
  • Among the 45 percent of patients who were married, one-third did not choose their spouse as their proxy.
  • Female relatives were preferred over males. For example, interviewees chose daughters over sons by a margin of 3 to 1, and sisters were twice as likely to be chosen as proxies compared to brothers.
  • Nine out of 10 were supportive of doctors asking their patients to choose a proxy, and almost the same number said they would do so right away if their doctor asked them at that very moment.
  • However, just over one-quarter said they had ever been asked to consider naming a proxy by their doctors.
  • Only 18 percent of those interviewed had a proxy at the time, and just five percent knew for sure that they had given a copy of their proxy to their physician.

Lipkin said the findings should alert physicians that patients are more than willing to discuss the issue of health care proxies and related issues.

Everyone would benefit by talking things over while the patient is healthy, rather than dealing with these potentially difficult decisions when a crisis is at hand.

"What I think the public needs to know is that there's nothing better than having a human being to use their best judgment to speak for you when you can't," said Lipkin.

Living wills are available, but, "as an instructional document, a living will can not anticipate the ever-changing flow of issues when you're in coma, or unconscious or injured, or undergoing surgery," according to Lipkin. "So, a lot of times, the instructional documents alone -- which are static and unchanging -- are misinterpreted. Patients are much better off naming a trusted loved person as their medical proxy and giving them verbal power of attorney for health care," he said.

Another expert agreed. Lis Nielsen, the program director for the Psychological Development and Integrative Science department at the U.S. National Institute on Aging in Bethesda, Md., supported Lipkin's call for a greater focus on health care proxies.

However, she sees the establishment of a health proxy as just one piece of a good advanced-care plan.

Advanced-care planning is "not a one-shot decision," Nielsen stressed. "It's certainly an important part of planning, as people are living longer. But, as the author points out, keeping the channels of communication open is the key. You have to have continuing discussions with whomever you choose to make decisions for you if you become incapacitated, since your preferences can change over time. And you also have to open up an ongoing dialogue with care providers to facilitate having your wishes attended to later in your life."

"So, appointing a healthy proxy is one part of a project that could include a conversation about advanced directives -- namely, stating what I do or don't want to happen to me -- as well as long-term assisted care options," added Nielsen. "Naming a proxy is not a decision that you make and you're done."

More information

For more on health care proxies and other advanced-care issues, head to the AARP.

SOURCES: K. Michael Lipkin, M.D., assistant professor, clinical preventive medicine, department of preventive medicine, Feinberg School of Medicine, Northwestern University, Chicago; Lis Nielsen, Ph.D., program director, Psychological Development and Integrative Science, National Institute on Aging, Bethesda, Md.; August 2006 Journal of General Internal Medicine
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