It is safe to assume that an individual is capable of making their own medical decisions, until they are determined unfit to do so. If a person is incapable to make their own decisions or speak for themselves on the matter of personal healthcare, their attending physician will give an opinion that the patient lacks the capacity to give informed consent. Before becoming incapacitated, a person can sign a document that names someone as their surrogate, or proxy, to make his or her medical decisions. This form is signed by the patient with two adult witnesses present, one of whom must not be a spouse or blood relative, and can designate both a proxy and an alternate in the case that the original is unwilling or unable to perform their duties.
A healthcare surrogate has the jurisdiction to make any and all medical decisions for the patient during their time of mental incapacity. One may also appoint a separate surrogate to consent to mental health treatment in the event that he or she is determined by a court to be mentally incompetent.
The surrogate is charged with making any and all healthcare decisions in congruence with the prior instructions given by the patient for whom they are serving. These decisions include consenting, refusing to consent or withdrawing consent to any and all medical treatment, as well as life-prolonging procedures. If there is no expression of what the patient would have chosen, the surrogate must consider their best interest in deciding what treatments are to be administered or withheld. The proxy's duties also include applying for private, government, or veterans' benefits to help bear the costs of healthcare. The surrogate also has the right to access all of the patient’s medical records to assist them in making decisions involving medical care and to apply for benefits.
With the commencement of the surrogate’s authority, the patient's spouse or adult children must be made aware that such an appointment has been made and that the proxy now has the authority to make the decisions. The proxy's authority to make healthcare decisions remains effective until there is a determination that the person who was labeled as incapacitated regains their ability to make medical decisions.
If the surrogate is unable or unwilling to make medical decisions in accordance to the patient’s expressed wishes and no alternate is named, the healthcare facility caring for the patient may seek the appointment of a healthcare proxy.