Who is a patient advocate?

Someone to whom you assign decision-making powers to act on your behalf in a medical scenario.

When do I need a patient advocate?

When you are unable to participate in medical treatment decisions yourself. Until that time, you make your own decisions directly.

How might I become unable to participate in medical or mental health deci-

sions? You might have a temporary loss of ability to make or communicate decisions if, for example, you had a stroke or were knocked unconscious in a car accident. You might suffer permanent loss through a degenerative condition, such as dementia. You might become unable to make mental health decisions if a condition such as severe depression or schizophrenia affected your mood or thought process.

Who determines I am no longer able to participate in these decisions?

The doctor responsible for your care (along with another independent doctor who examines you) will make that determination in the case of medical decisions. Your family members can also seek the help of a patient-advocate, if they feel vulnerable and find it difficult to negotiate the complex processes at the hospital you are admitted in.

What powers can I assign to a patient advocate?

You can give a patient advocate power to make those personal care decisions you normally make for yourself. For example, you can give your patient advocate power to consent to or refuse medical treatment for you; arrange for mental health treatment, home health care or adult day care; or admit you to a hospital, nursing home or home for the aged. You can also authorize your patient advocate to make a gift of your organs or body, to be effective upon your death.

Will my patient advocate have power to handle my financial affairs?

You can give your patient advocate power to arrange for medical and personal care services, and to pay for those services using your funds. Your patient advocate will not have general power to handle all your property and finances.

Can I give my patient advocate the right to withhold or withdraw treatment that would allow me to die?

Yes, but you must express in a clear and convincing manner that your patient advocate is authorised to make such decisions, and you must acknowledge these decisions could or would allow your death.

What if I don’t express any specific wishes concerning medical treatment?

Your patient advocate must then make decisions about your medical care in what he believes is in your best interests.

Will a hospital allow my patient advocate to review my records?

Yes. A patient has the right to inspect and copy his hospital records. Your patient advocate has the same right you have, once you have granted this to him, and are unable to participate in treatment decisions.

Whom can I appoint as patient advocate?

Any person age 18 or older is eligible; you can appoint your spouse, an adult child, a friend or other individual. You should choose someone you trust, who can handle the responsibility, and who is willing to serve.

Can I appoint a second person to serve as patient advocate in case the first per- son is unable to serve?

Yes. It is a good idea to do so.

What does a patient advocate need to do before acting in my behalf?

Before the patient advocate can act, he or she must sign an acceptance. This can be done at the time you complete the document.

Is there a required form for the document?

No. You may choose to use the sample form that we have given in this book, after making suitable changes in accordance with your specific medical needs.

Once I sign, can I later change my mind?

Yes. You may want to name a different patient advocate or alter the expression of your wishes. So long as you are of sound mind, you can sign a new document and then destroy the old one. Regardless of your physical or mental condition, you can revoke or cancel the document if it does not reflect your current wishes. Also, any spoken wish to have a specific life-extending treatment provided must be honoured by a patient advocate, even if the wish contradicts a written directive.

Can my patient advocate refuse to act in my behalf?

Yes. A patient advocate can revoke his acceptance at any time. If so, your named successor would become patient advocate.

What if there is a dispute when my patient advocate is making decisions for me?

If an interested person disputes whether the patient advocate is acting in your best interests, or has the authority to act in your behalf, the interested person may petition the local court to resolve the dispute.

What if I regain the ability to participate in medical decisions?

You can suspend the powers of your patient advocate during the time you are able to participate in decisions.

What if I have no one to appoint as a patient advocate?

You can write an advance health care directive (also known as a living will), which is a set of written instructions you give that specifies what actions should be taken for your health if you are no longer able to make decisions due to illness or incapacity. You can see a model of a living will at https://www.agingwithdignity.org/. You can also create a durable power of attorney for health care, where you empower an agent (known as your health care proxy) to make health care decisions for you.