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A health care proxy is a person you choose to make health care decisions for you if you become unable to make or communicate them yourself. The proxy—also called a health care agent, representative, or surrogate—speaks for you according to your wishes and the authority granted by your state’s rules and appointment form. In the United States, the role is commonly assigned through a durable power of attorney for health care.
What a health care proxy does
A proxy is a decision-maker, not simply a document listing treatments. If you cannot make or communicate decisions, the proxy helps your care team understand your wishes and make choices within the authority provided by your form and applicable state law. As the National Institute on Aging (NIA) explains, a health care proxy “is a person who can make health care decisions for you if you are unable to communicate these yourself.” NIA’s guidance was reviewed October 31, 2022.
The exact point when the proxy’s authority begins depends on the form and state law. Some forms specify how incapacity must be determined. For example, North Carolina’s statutory form says the agent’s authority begins when a specified physician determines that the person lacks capacity to make or communicate health care decisions; that is a North Carolina example, not a nationwide rule. North Carolina General Statutes § 32A-25.1
How a proxy differs from a living will
Both are forms of advance care planning, but they serve different purposes. A living will records treatment preferences for a time when you cannot communicate. A durable power of attorney for health care appoints a person to make decisions. You may have one or both, depending on your needs and state rules. NIA’s overview of advance directives explains these common documents.
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| Document | Main function | Where it can help |
|---|---|---|
| Health care proxy appointment | Names someone to make decisions within the granted authority. | Especially useful when a situation or choice is not addressed in written instructions. |
| Living will | Records treatment preferences. | Gives clinicians and your proxy guidance about treatments you do or do not want. |
What decisions the proxy may make
The authority can cover a broad range of health care decisions or a narrower set, depending on your form and state law. Areas may include treatment choices, providers, care location, and access to relevant health information. Read the state form to understand its scope and any limits; do not assume a proxy has identical powers in every state.
The proxy’s role is to represent your wishes, not substitute their own preferences. If they do not know what you would want in a particular situation, they should try to decide what you would choose. Discussing your values and priorities in advance can help them do that. MedlinePlus’s guidance on health care agents describes this responsibility.
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How to choose a health care proxy
Choose someone you trust to understand your wishes, communicate clearly, and handle difficult conversations with clinicians or family. The person does not have to be a relative under general federal guidance, but must meet your state’s eligibility rules. Consider naming an alternate if your state form permits it.
- Can you talk openly with this person about your health care preferences?
- Will they try to honor your wishes even if they disagree with them?
- Can they listen, ask questions, and manage differing views from family or clinicians?
- Are they likely to be reachable when needed, and willing to take on the responsibility?
- Do they meet the age and other eligibility requirements in your state?
Ask the candidate directly before naming them. Eligibility restrictions vary: NIA notes that most states set a minimum age of 18, while Alabama and Nebraska set 19, and that some people connected to a provider or care facility may be ineligible. Check your own state’s rules rather than relying on a general age or disqualification rule.
How to make the appointment official
- Find the form for your state. Use the durable power of attorney for health care or equivalent form approved where you live. Documents have different names across states, so a generic form may not satisfy local requirements. NIA links to free state forms in its proxy guidance.
- Read the instructions before signing. Check who may serve, how the proxy’s authority begins, what decisions the document covers, and whether witness signatures or notarization are required.
- Complete and execute the form as directed. Follow the state form’s signing requirements; do not assume that signing alone is enough.
- Get state-specific help if anything is unclear. Consult your state health department or legislature, state bar association, or legal aid office.
What to do after naming a proxy
Give your proxy a copy of the signed form and talk through your values and preferences—not just specific treatments. Share your providers’ names and contact details, and make sure your health care team knows whom to contact. You can also tell family members who your proxy is so they understand the arrangement. New York State’s Attorney General offers state-specific information and illustrates why terminology and requirements should be checked locally.
Review your advance care planning after a major change in health or circumstances, or a move to another state. NIA recommends reviewing directives at least once a year and after major life events. If you change your proxy, notify the former and new proxies, family, and clinicians, and distribute the updated document.
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What happens if you have no proxy
If you cannot make decisions and have no advance directive, state law determines who may act. The order varies. NIA says the decision-maker is typically a spouse, parents if available, or adult children, but those categories and their priority are not uniform. An unmarried partner may not automatically have authority, so check local law rather than assuming a relative or partner can decide.
A directive also cannot guarantee that every preference will be followed exactly in every clinical circumstance. NIA notes that clinical ambiguity, a provider’s conscience, institutional policy, or accepted standards may affect whether a directive can be followed. If a provider refuses, NIA says the provider must inform the proxy and consider transfer of care. NIA’s conversation guide provides further advance-planning context.
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