How to Make Decisions as a Healthcare Agent

cartoon of man explaining how to make decisions as a healthcare agent

If you agree to serve as someone’s health care agent or health care surrogate, you are compelled to make health care decisions for them “in accordance with their best interest but in light of their personal values,” to the extent such values are known to you (Uniform Health Care Decisions Act, 2).

What does this mean you must do in practice? In this article, we review your responsibilities in serving as a health care agent and include tips from several states.

Making decisions in the principal’s “best interest”

What constitutes someone’s “best interest”? While most state’s legislation is silent on how to determine the best interest of the principal, health care agents looking for general guidance might reference the Maryland Health Care Decisions Act. “Best interest” under MD Code Ann. 5-601 means that the benefits to the individual resulting from a treatment outweigh the burdens to the individual resulting from that treatment, taking into account:

  • The effect of the treatment on the physical, emotional, and cognitive functions of the individual;
  • The degree of physical pain or discomfort caused to the individual by the treatment, or the withholding or withdrawal of the treatment;
  • The degree to which the individual’s medical condition, the treatment, or the withholding or withdrawal of treatment result in a severe and continuing impairment of the dignity of the individual by subjecting the individual to a condition of extreme humiliation and dependency;
  • The effect of the treatment on the life expectancy of the individual;
  • The prognosis of the individual for recovery, with and without the treatment;
  • The risks, side effects, and benefits of the treatment or the withholding or withdrawal of the treatment; and
  • The religious beliefs and basic values of the individual receiving treatment, to the extent these may assist the decision maker in determining best interest

Making decisions in light of the principal's values

Hopefully, the principal for whom you are serving as agent discussed with you some of their core values and beliefs at a time when the principal had the capacity to understand, make, and communicate health care decisions.

If the principal named you as health care agent under a broader advance health care directive, that advance health care directive may include a living will detailing preferences for end-of-life care or mental health care. Although a living will is unlikely to address all possible decisions you may need to make as a health care agent, you can pair the written instructions it contains with what you know based on your relationship with the principal to extrapolate which decision the principal would most likely make.


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