What if any instructions or limitations should I give to my agent?
This section contains information on:
  • Discussing your wishes with your agent
  • Listing specific wishes or restrictions in your health care proxy
  • Common types of care/treatment to consider
Discussing your wishes with your agent
Having an open and frank discussion about your wishes with your health care agent will put him or her in a better position to serve your interests. Your agent must act according to your wishes, and if your agent does not know your wishes or beliefs, your agent is legally required to act in your best interest. Because this is a major responsibility for the person you appoint as your health care agent, you should have a discussion with the person about what types of treatments you would or would not want under different types of circumstances, such as:
  • whether you would want life support initiated/continued/removed if you are in a permanent coma;
  • whether you would want treatments initiated/ continued/removed if you have a terminal illness;
  • whether you would want artificial nutrition and hydration initiated/withheld or continued or withdrawn and under what types of circumstances.
Listing specific wishes or restrictions in your health care proxy

On the New York Health Care Proxy form, you have the option to write examples of the types of treatments that you would not desire and/or those treatments that you want to make sure you receive. The instructions may be used to limit the decision-making power of the agent. Your agent must follow your instructions when making decisions for you.

The decision to write out specific examples is a personal one.  You may have strong feelings about a particular state of health (i.e. coma, being unable to communicate) or about particular treatments (CPR, mechanical ventilation, feeding tubes). If you clearly express a particular wish, or gave particular treatment instructions, your agent has a duty to follow those wishes or instructions unless he or she has a good faith basis for believing that your wishes changed or do not apply to the circumstances.

If you do not state any limitations, you give your agent broad authority to make all health care decisions that you could have made, including the decision to consent to or refuse life-sustaining treatment.

Common examples of specific instructions:

  • If I become terminally ill, I do/don't want to receive the following types of treatments...
  • If I am in a coma or have little conscious understanding, with no hope of recovery, then I do/don’t want the following types of treatments:...
  • If I have brain damage or a brain disease that makes me unable to recognize people or speak and there is no hope that my condition will improve, I do/don’t want the following types of treatments:...
Common types of care/treatment to consider
Cardiopulmonary resuscitation:
  What is CPR?
 
  • Cardiopulmonary resuscitation (CPR) is a group of treatments used when someone's heart and/or breathing stops. It is used in an attempt to try to restart the heart and breathing. 
  • It may consist only of one or more of the following:
   
  • mouth-to-mouth breathing
  • pressing on the chest to mimic the heart's function and cause blood to circulate. 
  • electric shock to stimulate the heart
  • drugs to stimulate the heart. 
    •   What can I expect?
     
    • CPR can be life saving, when used quickly in response to a sudden event such as a heart attack or drowning
    • The success rate is extremely low for people who are at the end of a terminal disease process.
    • Critically ill patients who receive CPR have a small chance of recovering and leaving the hospital. 
    • CPR is not without risks. Pressing on the chest can cause a sore chest, broken ribs or a collapsed lung
      CPR on your health care proxy
     
    • In New York, your agent will have the authority to decide whether or not doctors and nurses should try to restart your heart beat by using cardiopulmonary resuscitation (CPR), unless you specify on your Health Care Proxy form that your agent cannot make this decision for you.
    • You should discuss with your agent under what, if any, circumstances you would find CPR acceptable or unacceptable
    Mechanical ventilation:
      What is Mechanical ventilation?
     
    • Mechanical ventilation is used to support or replace the function of the lungs. 
    • A machine called a ventilator (or respirator) forces air into the lungs.  The ventilator is attached to a tube inserted in the nose or mouth and down into the windpipe (or trachea). 
      Why is it used?
     
    • To assist a person through a short-term problem
    • To support life or for prolonged periods in which irreversible respiratory failure exists due to injuries to the upper spinal cord or a progressive neurological disease.
      What can I expect?
     
    • Some people on long-term mechanical ventilation are able to enjoy themselves and live a quality of life that is important to them. 
    • For the dying patient, however, mechanical ventilation often prolongs the dying process until some other body system fails.  It may supply oxygen, but it cannot improve the underlying condition.
      Potential issues to discuss with your agent and/or list on your health care proxy
     
    • If you would never regain the ability to breath on your own or return to a quality of life acceptable to you, would you want mechanical ventilation?
    • If you are on mechanical ventilation and there is little hope of you regaining the ability to breath on your own or returning to an acceptable quality of life, would you want to be taken off the ventilator?
    • Under what circumstances, if any, would mechanical ventilation be acceptable to you?
    • If doctor’s had reasonable hope that you could breath on your own or return to a quality of life acceptable to you, would you want a limited trial of mechanical ventilation?
    Other examples of medical treatments about which you may wish to give your agent special instructions (this is not a complete list):
      • artificial nutrition and hydration • antipsychotic medication • electric shock therapy
      • antibiotics • surgical procedures • dialysis
      • transplantation • blood transfusions • abortion
      • sterilization    
    Some examples of types (or levels) of care
    Comfort Care
    • Keep me warm, dry and pain free. 
    • Do not transfer to hospital unless absolutely necessary. 
    • Only give measures that enhance comfort or minimize pain.
    • Start or continue an intravenous (IV) line only if it improves comfort. 
    • Do not take x-rays or blood tests or give antibiotics unless they are given to improve comfort
    Limited Care
    • I may or may not be transferred to the hospital. 
    • Intravenous (IV) therapy may be appropriate. 
    • Antibiotic use should be limited. 
    • A trial of appropriate drugs may be used. 
    • No invasive procedures. 
    • Do not transfer to Intensive Care Unit.
    Surgical Care
    • Transfer me to acute care hospital for evaluation.
    • Perform emergency surgery if necessary. 
    • Do not admit to Intensive Care Unit. 
    • Do not ventilate except during and after surgery (i.e. tube down throat and connected with machine)
    Intensive Care
    • Transfer to acute care hospital without hesitation. 
    • Admit to Intensive Care Unit if necessary. 
    • Ventilate me if necessary. 
    • Insert central line (i.e. main arteries for fluids when other veins collapse). 
    • Provide surgery, biopsies, all life-support systems and transplant surgery. 
    • Do everything possible to maintain life
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