A health care surrogate is the person who makes medical decisions for you when you can’t make or communicate them yourself. It might happen after a stroke, during surgery, in the late stages of dementia or at the end of life.
Naming a surrogate ahead of time is one of the kindest things you can do for your family. Without one, the people who love you may have to make hard decisions under pressure, without knowing what you would have wanted, and sometimes without agreeing with each other.
This article is general information, not legal advice. Laws and forms vary by state, so talk with an attorney about your own situation.
It goes by different names
Depending on the state, the same role may be called a:
- Health care surrogate. In Florida, for example, you name one with a Designation of Health Care Surrogate form.
- Health care agent. In North Carolina, you name your health care agent in a Health Care Power of Attorney.
- Health care proxy or medical power of attorney in other states.
The names differ, but the idea is the same: a person you trust, named in writing, who speaks for you about medical care.
What a surrogate does
A surrogate usually steps in only when a doctor determines that you can’t make your own decisions. From there, the surrogate may:
- Talk with doctors and nurses and ask questions about treatment
- Agree to or refuse tests, procedures and treatments on your behalf
- Make decisions about moving to rehab, a nursing home or home care
- Make decisions at the end of life, including about life support
A good surrogate decides based on what you would want, not what they would choose for themselves. That’s why the conversation you have with them now matters as much as the form.
What happens if no one is named
Most states have a law that sets a default order of family members who can make certain decisions, often starting with a spouse and then adult children. North Carolina has one. These rules can still leave families stuck: adult children may disagree, the right person may be hard to reach, and in some cases a court has to appoint a guardian. Naming someone in advance avoids most of that.
How to choose your surrogate
The right person isn’t always your spouse or your oldest child. Look for someone who:
- Knows your values and will honor them, even if they would choose differently
- Can stay calm and ask questions in a hospital setting
- Is likely to be reachable when it matters
- Is willing to take on the role, so ask them first
It’s a good idea to name a backup in case your first choice isn’t available.
Put your wishes in writing, too
A surrogate works best alongside a living will (also called an advance directive), which states your wishes about life-prolonging treatment. The living will speaks for you in the situations you can predict. Your surrogate speaks for you in the ones you can’t.
Give copies to your surrogate, your doctors and anyone else who should have one, and keep the original somewhere easy to find.
Where a patient advocate fits
A patient advocate doesn’t replace your surrogate, but can make the role much easier to carry. Surrogates are often adult children who live far away, or spouses who are worn out from caregiving. An advocate can explain the medical situation in plain language, join care meetings, help the surrogate understand the options and make sure the patient’s wishes are heard.
Cheryl A. Scharoun, RN, BSN, BCPA, has served as a health care surrogate and supports families who hold this role. If you’re facing these decisions for someone you love, the first consultation is free.