Proxy Law allows you to appoint someone you trust — for example, a family member or close friend – to make health care decisions for you if you lose the ability to make decisions yourself. By appointing a health care agent, you can make sure that health care providers follow your wishes. Your agent can also decide how your wishes apply as your medical condi

tion changes. Hospitals, doctors and other health care providers must follow your agent’s decisions as if they were your own. You may give the person you select as your health care agent as little or as much authority as you want. You may allow your agent to make all health care decisions or only certain ones. You may also give your agent instructions that he or she has to follow. This form can also be used to document your wishes or instructions with regard to organ and/or tissue donation. About the Health Care Proxy FormThis is an important legal document.      

Before signing, you should understand the following facts:

1.  This form gives the person you choose as your agent the authority to make all health care decisions for you, including the decision to remove or provide life-sustaining treatment, unless you say otherwise in this form. “Health care” means any treatment, service or procedure to diagnose or treat your physical or mental condition.

2.  Unless your agent reasonably knows your wishes about artifcial nutrition and hydration (nourishment and water provided by a feeding tube or intravenous line), he or she will not be allowed to refuse or consent to those measures for you.

3.  Your agent will start making decisions for you when your doctor determines that you are not able to make health care decisions for yourself.

4.  #p#分頁標(biāo)題#e#You may write on this form 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.

5.  You do not need a lawyer to fll out this form.6.  You may choose any adult (18 years of age or older), including a family member or close friend, to be your agent. If you select a doctor as your agent, he or she will have to choose between acting as your agent or as your attending doctor because a doctor cannot do both at the same time. Also, if you are a patient or resident of a hospital, nursing home or mental hygiene facility, there are special restrictions about naming someone who works for that facility as your agent. Ask staff at the facility to explain those restrictions.

7.  Before appointing someone as your health care agent, discuss it with him or her to make sure that he or she is willing to act as your agent. Tell the person you choose that he or she will be your health care agent. Discuss your health care wishes and this form with your agent. Be sure to give him or her a signed copy. Your agent cannot be sued for health care decisions made in good faith.

8. If you have named your spouse as your health care agent and you later become divorced or legally separated, your former spouse can no longer be your agent by law, unless you state otherwise. If you would like your former spouse to remain your agent, you may note this on your current form and date it or complete a new form naming your former spouse

.9.  Even though you have signed this form, you have the right to make health care decisions for yourself as long as you are able to do so, and treatment cannot be given to you or stopped if you object, nor will your agent have any power to object

.10. You may cancel the authority given to your agent by telling him or her or your health care provider orally or in writing.

#p#分頁標(biāo)題#e#11. Appointing a health care agent is voluntary.  No one can require you to appoint one.

12. You may express your wishes or instructions regarding organ and/or tissue donation on  this form. Frequently Asked QuestionsWhy should I choose a health care agent? If you become unable, even temporarily, to make health care decisions, someone else must decide for you. Health care providers often look to family members for guidance.

 Family members may express what they think your wishes are related to a particular treatment. However, in New York State, only a health care agent you appoint has the legal authority to make treatment decisions if you are unable to decide for yourself. Appointing an agent lets you control your medical treatment by:

• allowing your agent to make health care decisions on your behalf as you would want  them decided;

• choosing one person to make health care decisions because you think that person would make the best decisions;

• choosing one person to avoid confict or confusion among family members and/or signifcant others.You may also appoint an alternate agent to take over if your frst choice cannot make decisions  for you.Who can be a health care agent?Anyone 18 years of age or older can be a health care agent. #p#分頁標(biāo)題#e#

The person you are appointing as your agent or your alternate agent cannot sign as a witness on your Health Care Proxy form.How do I appoint a health care agent? All competent adults, 18 years of age or older, can appoint a health care agent by signing a form called a Health Care Proxy. You don’t need a lawyer or a notary, just two adult witnesses. Your agent cannot sign as a witness. You can use the form printed here, but you don’t have to use this form.When would my health care agent begin to make health care decisions for me?

 Your health care agent would begin to make health care decisions after your doctor decides that you are not able to make your own health care decisions. As long as you are able to make health care decisions for yourself, you will have the right to do so.What decisions can my health care  agent make?

Unless you limit your health care agent’s authority, your agent will be able to make any health care decision that you could have made if you were able to decide for yourself. Your agent can agree that you should receive treatment, choose among different treatments and decide that treatments should not be provided, in accordance with your wishes and interests. However, your agent can only make decisions about artifcial nutrition and hydration (nourishment and water provided by feeding tube or intravenous line) www.400190.com

 if he or she knows your wishes from what you have said or what you have written. The Health Care Proxy form does not give your agent the power to make non-health care decisions for you, such as  fnancial decisions.Why do I need to appoint a health care agent if I’m young and healthy?

Appointing a health care agent is a good idea even though you are not elderly or terminally ill. A health care agent can act on your behalf if you become even temporarily unable to make your own health care decisions (such as might occur if you are under general anesthesia or have become comatose because of an accident).

#p#分頁標(biāo)題#e# When you again become able to make your own health care decisions, your health care agent will no longer be authorized to act.How will my health care agent  make decisions? Your agent must follow your wishes, as well as your moral and religious beliefs. You may write instructions on your Health Care Proxy form or simply discuss them with your agent.How will my health care agent know  my wishes?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. 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 deposit box.

Bring a copy if you are admitted to the hospital, even for minor surgery, or if you undergo outpatient surgery.May I use the Health Care Proxy form to express my wishes about organ and/or  tissue donation?

Yes. Use the optional organ and tissue donation section on the Health Care Proxy form and be sure to have the section witnessed by two people. You may specify that your organs and/or tissues be used for transplantation, research or educational purposes.

Any limitation(s) associated with your wishes should be noted in this section of the proxy. Failure to include your wishes and instructions on your Health Care Proxy form will not be taken to mean that you do not want to be an organ and/or tissue donor.Frequently Asked Questions, continuedCan my health care agent make decisions for me about organ and/or tissue donation?Yes. As of August 26, 2009, your health care agent is authorized to make decisions after your death, but only those regarding organ and/or tissue donation. Your health care agent must make  such decisions as noted on your Health Care  Proxy form.Who can consent to a donation if I choose not to state my wishes at this time?

It is important to note your wishes about organ and/or tissue donation to your health care agent, the person designated as your decedent’s agent, if one has been appointed, and your family members. New York Law provides a list of individuals who are authorized to consent to organ and/or tissue donation on your behalf. They are listed in order of priority: your health care agent; your decedent’s agent; your spouse, if you are not legally separated, or your domestic partner; a son or daughter 18 years of age or older; either of your parents; a brother or sister 18 years of age or older; or a guardian appointed by a court prior to the#p#分頁標(biāo)題#e#  donor’s death. www.400190.com