What is a Healthcare Surrogate?

healthcare surrogate is someone who is legally responsible for making healthcare decisions for another person when they cannot make decisions for themselves. Healthcare surrogates, also called healthcare proxies, can be either legally designated or entitled to be a healthcare surrogate because of their relationship to the patient.

Most people wanting to learn more about healthcare surrogates will either be considering naming their own healthcare surrogates or in the position of acting as a healthcare surrogate for someone else. 

Healthcare surrogacy is a very important decision with far-reaching implications, making it very important to understand how this process works and what it means to be a healthcare surrogate.

What Do Healthcare Surrogates Do?

Healthcare surrogates make medical decisions for other people in the same way that they would make their own medical decisions if they could. People filling this role only make healthcare decisions for the person they are acting as a surrogate for (if that person is unable to make and express their own wishes).

Someone who is named as a healthcare surrogate has no role in making decisions for others if they are still able to make their own healthcare choices.

Healthcare surrogates are expected to take the time to understand the medical situation of the person they are representing and to make the decisions that they believe that person would have wanted.

Normally, healthcare surrogates are allowed to make decisions at their own discretion, and the doctors and nurses caring for a patient are required to follow decisions that are made by the healthcare surrogate. 

Who Can Be a Healthcare Surrogate?

Anyone who is 18 years old or older who is considered a competent adult can be a healthcare surrogate, but will only become a healthcare surrogate under specific situations. There are two main ways that someone becomes a healthcare surrogate. 

Default Healthcare Surrogates

The first way someone can become a healthcare surrogate is by legal default. If someone suddenly becomes unable to make their own healthcare decisions, there is a list of people who are entitled to make decisions for them if they have not specifically named a healthcare surrogate.

This list can vary by state, but normally consists of (in order of priority):

  1. The patient’s spouse
  2. The patient’s child or children
  3. The patient’s parent or parents
  4. The patient’s sibling or siblings
  5. The next closest relative to the patient
  6. A close friend of the patient 

Using a list like this, someone who has no spouse and children, for example, would have their parents as their default healthcare proxies. In cases where a group of people, such as a patient’s children, are the default healthcare proxies, each person in the group is legally entitled to have an equal say.

Many times to avoid the complexities of having a “vote”, a group like this will select a single person to act on the patient’s behalf.

Technically, parents or legal guardians are the healthcare surrogates for their children until they reach the age of 18. The surrogacy may not apply to certain medical decisions, depending on the laws of each particular state.

Appointed Healthcare Surrogates

The second way that someone can become a healthcare surrogate is by being legally appointed to this role. This occurs when someone completes legal paperwork nominating someone to this role.

You can typically nominate multiple people, prioritizing them if your first choice is unavailable. 

You can also have a group of more than one person act as your healthcare surrogate and require a majority or unanimous consent for decisions.

There can be many reasons that someone chooses to appoint a person as their healthcare surrogate. Typically, someone would prefer to have someone else make their medical decisions than the person or people who would be the default healthcare surrogate. This can also help to clarify situations where the default surrogates would be a group of more than one individual, such as siblings or parents, that could have conflicting views.

While your appointed healthcare surrogate can be a close family member or friend, you can appoint anyone you choose to be your healthcare surrogate. You are not required to get the consent of the person you name, but they are allowed to refuse the responsibilities of being a healthcare surrogate when the time comes.

Tips For Choosing a Healthcare Surrogate

Choosing who you want to make medical decisions for you is an important decision. Typically, when you are not able to make your own healthcare decisions the situation is very serious, and the decisions can have a tremendous impact on your wellbeing.

Choose Someone You Can Trust

Your life will literally be at the control of another person if you are not able to make your own medical decisions. You will want that person to be someone that you trust, both to step up to the responsibilities if the time comes and and to make the best decisions. Having a healthcare surrogate who you can rely on to fulfill their role and to do it well is essential.

Choose Someone Who Cares About You

Ultimately, you will want a healthcare surrogate who cares about you and who has your best interests at heart every time they make a decision for you. If someone truly cares about you, they will ensure that your wishes are fulfilled when you cannot and make sure that your healthcare team is acting in your best interests.

Consider Potential Conflicts of Interest

It is a basic fact of human nature that people always consider their own interests when making any kind of decision. This will not typically be an issue with your healthcare surrogate, but if you are considering naming someone who stands to inherit after you pass or has another potential conflict, it is worth considering how these potential conflicts of interest could affect their decision-making process.

Choose Someone Who Understands Your Wishes

It is essential that your healthcare surrogate understand what your wishes are and how you think about medical decisions. Someone who has lived a long life and has terminal disease may not want aggressive, life-saving measures taken.

Conversely, someone who is young and has a family may be comfortable with the idea of being on life support for three months if that is what it takes to survive. You healthcare surrogate must be someone who knows what you personally would want in your specific situation and be willing to follow your wishes.

How to Designate a Healthcare Surrogate

To designate your surrogate decision-maker, you will need to complete legal paperwork. This is often referred to as a healthcare power of attorney, but may have different names.

The most thorough way to ensure the paperwork is correct is to have an attorney prepare it, however, there are forms you can get and fill out yourself. These may be available online or even through your hospital if you are a patient.

When designating a healthcare surrogate, be sure that you understand the paperwork you are completing. There may be options to limit the decision that can be made by a healthcare surrogate and how their role will work. If you are doing your paperwork without a lawyer, be sure that it is completed correctly and keep in mind that it may need to be witnessed, notarized, or both, depending on the laws in your state.

Thinking about who would make healthcare decisions in an emergency is not fun, but by planning ahead, you can ensure that you have the right person making your decisions.

Having a healthcare surrogate planned can also reduce the stress on your loved ones who may become surrogates by default and ensure that your care is provided the way that you want it.