The Critical Role of a Healthcare Proxy in Your Estate Plan

When middle-income families in Brooklyn think about estate planning, their minds typically go straight to wills, trusts, and how to distribute assets after they're gone. But estate planning isn't just about what happens after death—it's equally about protecting yourself and your loved ones during life's most vulnerable moments. One of the most essential yet frequently overlooked components of a comprehensive estate plan is the healthcare proxy.

A healthcare proxy, also known as a healthcare power of attorney, is a legal document that designates a trusted individual to make medical decisions on your behalf when you're unable to do so yourself. While you may feel healthy today, unforeseen circumstances—from sudden accidents to unexpected illnesses—can strike at any age, leaving you incapacitated and unable to communicate your wishes to healthcare providers.

Understanding the importance of a healthcare proxy and integrating it properly into your estate plan is not just a matter of legal prudence—it's an act of love that protects your family from agonizing uncertainty and potential conflict during already stressful medical crises.

What Is a Healthcare Proxy?

A healthcare proxy is a legal document recognized in New York State that allows you, the principal, to appoint someone you trust—called your healthcare agent or proxy—to make medical decisions for you if you become unable to make them yourself. Under New York's Health Care Proxy Law, any competent adult who is 18 years of age or older can create this document without the need for an attorney or notary, though professional guidance is always recommended.

The healthcare proxy only takes effect when your physician determines that you lack the capacity to make or communicate healthcare decisions. Until that point, you retain complete control over all medical choices. This means your agent cannot override your decisions while you remain competent, preserving your autonomy while providing a safety net for unexpected incapacitation.

Your healthcare agent has broad authority to make nearly any healthcare decision you could make yourself, including:

• Consenting to or refusing medical treatments and procedures

• Choosing healthcare providers and facilities

• Deciding about diagnostic tests and medications

• Making decisions about life-sustaining treatment

• Accessing your medical records through HIPAA authorization

• Determining whether you should be admitted to or discharged from a hospital

In New York, you can also appoint an alternate or successor agent in case your primary choice is unavailable or unable to serve when needed. This ensures continuous protection regardless of circumstances.

Why a Healthcare Proxy Is Essential to Your Estate Plan

Ensures Your Medical Wishes Are Honored

The most fundamental reason for having a healthcare proxy is to ensure that medical decisions align with your values, beliefs, and preferences. When you're unable to communicate—whether due to unconsciousness, dementia, severe illness, or injury—your healthcare agent becomes your voice in the medical system.

Without a healthcare proxy, medical providers may default to the most aggressive treatment available, which may not align with what you would have wanted. Alternatively, if your condition requires withholding certain treatments, providers may be hesitant to act without clear authorization, potentially prolonging suffering.

By designating a healthcare agent and discussing your wishes with them in advance, you create a framework for decision-making that reflects your personal philosophy about medical care, quality of life, and end-of-life treatment.

Prevents Family Conflict and Confusion

Healthcare crises are emotionally charged situations that can quickly spiral into family disputes when there's no clear decision-maker. Adult children may disagree with each other or with a surviving spouse about what treatments their loved one should receive. Siblings might have vastly different interpretations of what their parent "would have wanted," leading to bitter arguments at hospital bedsides.

The healthcare proxy eliminates this ambiguity by legally designating one person as the decision-maker. While other family members can still provide input and support, the designated agent has the final authority, reducing the potential for conflicts that can fracture family relationships during already difficult times.

This clarity is particularly valuable for blended families, estranged relatives, or situations where family members have different values regarding medical intervention. By making your choice clear in advance, you prevent your loved ones from having to guess at your preferences or fight over who has the right to decide.

Avoids Court Intervention and Guardianship Proceedings

If you become incapacitated without a healthcare proxy, New York law does provide a hierarchy of family members who can make decisions on your behalf under the Family Health Care Decisions Act (FHCDA). However, this default hierarchy may not reflect your actual preferences, and in complex situations, disagreements can lead family members to petition the court for guardianship.

Guardianship proceedings are time-consuming, expensive, and emotionally draining. They require legal representation, court hearings, and sometimes medical evaluations. The process can take weeks or months—time you may not have when urgent medical decisions are needed. Additionally, the court may appoint someone you wouldn't have chosen, and that person will need to report regularly to the court about your care.

A healthcare proxy completely bypasses this process. Your designated agent can begin making decisions immediately upon your incapacitation, without any need for court involvement. This saves your family thousands of dollars in legal fees and countless hours of stress during an already difficult time.

Provides Legal Authority and HIPAA Access

Medical privacy laws, particularly the Health Insurance Portability and Accountability Act (HIPAA), strictly limit who can access your medical information. Without proper authorization, even close family members may be denied access to crucial information about your condition, treatment options, and prognosis.

A properly executed healthcare proxy automatically includes HIPAA authorization, giving your agent full access to your medical records and the ability to speak directly with your healthcare providers. This legal authority enables them to make truly informed decisions based on complete medical information rather than partial or secondhand accounts. Furthermore, your healthcare agent has the legal standing to advocate for you with hospitals, doctors, insurance companies, and other healthcare providers. They can ensure you receive appropriate care, question treatment plans that don't align with your wishes, and authorize transfers to different facilities if necessary.

Complements Other Estate Planning Documents

A comprehensive estate plan addresses both your financial and healthcare needs. While a general power of attorney handles financial matters and a will or trust addresses asset distribution after death, the healthcare proxy specifically covers medical decision-making during incapacity.

These documents work together to create a complete safety net. For example, if you're hospitalized after a serious accident, your financial power of attorney can handle bill payments and manage your bank accounts, while your healthcare proxy makes medical decisions. Neither document can substitute for the other—you need both for full protection.

Additionally, while some people create living wills (also called advance directives) that outline specific treatment preferences, a healthcare proxy provides the flexibility to handle unforeseen situations that couldn't have been anticipated in a written document. Your agent can interpret your general values and apply them to specific medical scenarios that arise.

Healthcare Proxy vs. Living Will: Understanding the Difference

Many people confuse healthcare proxies with living wills, but these are distinct documents that serve different purposes in your estate plan. Understanding the difference helps you create more comprehensive healthcare protections.

A living will is a document that outlines your specific preferences for medical treatment in certain situations, particularly end-of-life scenarios. It typically addresses questions like whether you want life-sustaining treatments such as mechanical ventilation, artificial nutrition and hydration, or CPR if you're terminally ill, permanently unconscious, or unlikely to recover.

Living wills provide clear instructions but are limited in scope. They can only address situations you've anticipated and specifically documented. Medical emergencies, however, often involve complex, nuanced situations that don't fit neatly into predetermined categories.

A healthcare proxy, by contrast, designates a person rather than documenting specific treatments. Your agent can make decisions across the full spectrum of healthcare situations, from routine to extraordinary, based on your stated values and preferences. They can adapt to circumstances you couldn't have foreseen, ask questions of medical providers, and make judgment calls based on evolving medical information.

The key distinction: A living will tells healthcare providers what you want done; a healthcare proxy empowers someone you trust to make those decisions for you when circumstances require flexibility and judgment.

Most comprehensive estate plans include both documents. The living will provides general guidance and addresses your core values, while the healthcare proxy ensures someone you trust is empowered to interpret and apply those values to real-world medical situations. Your healthcare agent should always follow any clear instructions in your living will, but they have the authority to make decisions in situations your living will doesn't address.

Real-Life Consequences: When Healthcare Proxies Matter Most

The abstract benefits of a healthcare proxy become starkly real when examining actual cases where the presence or absence of this document dramatically affected outcomes.

The Terri Schiavo Case: A Cautionary Tale

Perhaps the most famous case illustrating the importance of advance healthcare planning is that of Terri Schiavo. In 1990, at age 26, Terri suffered cardiac arrest that left her in a persistent vegetative state with no hope of recovery. Tragically, she had never executed a healthcare proxy or living will.

For 15 years, Terri's husband Michael and her parents, the Schindlers, battled in court over whether to remove her feeding tube. Michael petitioned to end life support, stating this was what Terri would have wanted. Her parents vehemently disagreed and fought to keep her alive. The case eventually involved the Florida state legislature, the governor, the U.S. Congress, and multiple levels of the court system.

After years of legal battles, intensive media coverage, and immeasurable family anguish, the courts ultimately sided with Michael Schiavo. Terri's feeding tube was removed in March 2005, and she died shortly thereafter.

The lesson is heartbreaking but clear: Had Terri Schiavo designated a healthcare proxy and communicated her wishes to that person, her family could have avoided 15 years of conflict, millions of dollars in legal fees, and a very public, painful ordeal. Her designated agent could have made decisions privately, with legal authority, without subjecting the family to protracted litigation.

When Proxies Struggle With Difficult Decisions

Even when a healthcare proxy exists, challenges can arise if the designated agent struggles emotionally with the responsibility. Healthcare professionals have encountered situations where the person legally designated as the healthcare proxy becomes too distraught to make difficult decisions, effectively paralyzing the decision-making process.

In one such case, a retired school counselor named Loretta explicitly designated her eldest daughter as her healthcare proxy, describing her as the "strong one" in the family. Loretta had made her end-of-life wishes very clear: she did not want to die in a hospital and preferred comfort care over aggressive intervention.

When Loretta's health deteriorated, however, her daughter was too emotionally overwhelmed to make the necessary decisions. She deferred everything to the doctors and couldn't bring herself to authorize the transition to hospice care that her mother had clearly requested. Ultimately, Loretta's youngest son—who was not the designated proxy—had to find his mother's written instructions and advocate for bringing her home, where she died peacefully as she had wished.

This case illustrates an important consideration when choosing your healthcare agent: Strong emotional bonds don't always translate into the ability to make difficult medical decisions. The best healthcare proxy is someone who understands your wishes deeply but can also set aside their own emotions to honor what you want, even when it's painful to do so.

Family Disagreements Over Proxy Authority

Healthcare proxies can also face challenges when other family members refuse to accept the designated agent's authority. In one case, an elderly woman in a coma after a stroke had clearly designated her husband as her healthcare proxy. Based on their prior discussions, he authorized doctors to remove life support.

However, the couple's adult children challenged his decision, arguing that their mother would have wanted aggressive treatment. The disagreement escalated to the point where the hospital's ethics committee had to intervene to review the case and confirm that the husband, as the legal proxy, had the authority to make the decision based on his wife's previously expressed wishes.

While the healthcare proxy document provided clear legal authority, the family conflict created additional stress and delays. This underscores the importance of not just creating the document, but also having family discussions about your choices, so everyone understands your wishes and the reasons behind your designation.

Choosing the Right Healthcare Agent: What Brooklyn Families Should Consider

Selecting your healthcare proxy is one of the most personal and important decisions in estate planning. This person will literally speak for you when you cannot speak for yourself, so the choice deserves careful thought and honest conversation.

Essential Qualities to Look For

Trust and Integrity: Above all else, your healthcare agent must be someone you trust completely to put your interests and wishes ahead of their own feelings or preferences. They need the integrity to make decisions based on what you would want, not what they would want for themselves or what seems easiest.

Availability: Your agent should be someone who is likely to be available when needed. If you're hospitalized in Brooklyn, a sibling who lives across the country and travels frequently for work may not be able to reach you quickly in an emergency. While proximity isn't everything—phone consultations are common—it's one factor to consider.

Emotional Strength: Making healthcare decisions for someone you love, especially end-of-life decisions, requires emotional resilience. Your agent needs to be able to set aside their own fears and grief to focus on your wishes. Consider whether potential candidates can remain calm under pressure and make difficult choices even in emotionally charged situations.

Communication Skills: Your healthcare agent will need to communicate effectively with doctors, nurses, and other medical professionals. They should be comfortable asking questions, seeking clarification, and advocating for you if necessary. They'll also need to communicate with other family members about decisions being made.

Compatible Values: While your agent doesn't need to share all your beliefs, they should understand and respect your values, particularly regarding quality of life, religious considerations, and attitudes toward medical intervention. Someone whose fundamental values radically differ from yours may struggle to honor your wishes.

Willingness to Serve: Being a healthcare proxy is a significant responsibility. Before formally designating someone, have an honest conversation with them about what the role entails and confirm they're willing to accept this responsibility. Never appoint someone without their knowledge and consent.

Family Dynamics to Consider

For many Brooklyn families, particularly those with strong cultural and familial bonds, choosing a healthcare agent can be complicated by family dynamics. You may feel obligated to choose your eldest child, your spouse, or a particular family member due to tradition or expectation.

However, obligation shouldn't override practical considerations. The best healthcare agent isn't necessarily the oldest, the closest geographically, or the most prominent family member. It's the person best suited to the specific responsibilities involved.

If you have concerns about family members feeling slighted by your choice, consider having a family meeting to discuss your healthcare wishes openly. Explain your reasoning and make clear that your choice reflects the specific demands of the role, not your love or respect for others. This transparency can prevent hurt feelings and conflicts later.

Some families benefit from appointing co-agents who must make decisions together, but this approach requires careful consideration. While it can prevent one person from feeling overburdened, it can also create deadlock if the co-agents disagree. If you do choose co-agents, select people who communicate well with each other and are likely to reach consensus.

Naming an Alternate Agent

New York law allows you to designate both a primary healthcare agent and one or more alternate (successor) agents. This is highly recommended. Your primary agent may become unavailable due to their own illness, travel, family emergencies, or other circumstances. Without a designated alternate, the lack of an available agent could force your family back into the uncertainty you were trying to avoid.

When choosing your alternate, apply the same criteria you used for your primary agent. Discuss the role with them as well, and ensure they understand they may be called upon to serve. Keep both your primary and alternate agents informed about any changes to your health status or medical preferences.

The Process of Creating a Healthcare Proxy in New York

Creating a healthcare proxy in New York is relatively straightforward, but doing it correctly is crucial for ensuring the document will be honored when needed.

Legal Requirements in New York

Under New York law, any competent adult age 18 or older can execute a healthcare proxy. The document must be:

• Signed and dated by you, the principal

• Witnessed by two adults who are at least 18 years old

• Not witnessed by your designated healthcare agent or alternate agent

Notably, notarization is not legally required in New York, though some attorneys recommend it to add an extra layer of authenticity and reduce the chance of challenges. The witnesses cannot be your designated agents, but they don't need to be strangers—friends or family members who aren't serving as your agent can witness the document.

Recent amendments to New York law also allow for remote witnessing via audio-visual technology under specific circumstances, which became particularly relevant during the COVID-19 pandemic. If remote witnessing is used, the principal must display valid photo identification during the video conference, and the signed document must be transmitted electronically to the witness within 24 hours.

What to Include in Your Healthcare Proxy

The standard New York healthcare proxy form, available from the state Department of Health, includes spaces for:

• Your name and contact information

• Your agent's name and contact information

• Your alternate agent's name and contact information (optional but recommended)

• Any specific limitations on your agent's authority

• Any specific instructions about your care preferences

• The duration of the proxy (usually indefinitely until revoked)

• Your signature and date

• Witness signatures and dates

You can also attach additional pages with more detailed instructions about your medical preferences, values, and specific treatments you do or don't want. While not required, these instructions can provide valuable guidance to your agent and healthcare providers.

Working With an Estate Planning Attorney

While you can complete a basic healthcare proxy form on your own, working with an experienced estate planning attorney offers significant advantages, particularly for families with complex medical histories or family dynamics.

An attorney can help you:

• Ensure the document meets all legal requirements and will be enforceable when needed

• Integrate the healthcare proxy with your other estate planning documents

• Address unique family situations, such as blended families, estranged relatives, or cultural considerations

• Include appropriate language for specific medical conditions or preferences

• Consider implications of existing conditions like Alzheimer's disease or terminal illness

• Navigate sensitive family dynamics and potential conflicts

For Brooklyn families working with Alatsas Law Firm, the healthcare proxy is integrated into a comprehensive estate planning approach that considers your entire family situation, financial circumstances, and long-term goals. Rather than viewing the healthcare proxy as an isolated document, it's part of a holistic strategy to protect your family's wellbeing and honor your wishes in all circumstances.

Executing and Distributing Your Healthcare Proxy

Once your healthcare proxy is properly signed and witnessed, you should:

• Give a copy to your healthcare agent and alternate agent, and confirm they understand your wishes

• Give a copy to your primary care physician to be placed in your medical records

• Keep the original in a safe, accessible place—not a safe deposit box that others can't access in an emergency

• Give copies to close family members so they know who your designated agent is

• Carry a wallet card noting that you have a healthcare proxy and who your agent is

• Register it with any hospitals where you're likely to receive care

Simply creating the document isn't enough—people need to know it exists and where to find it when an emergency occurs.

Common Mistakes to Avoid

Even when people recognize the importance of a healthcare proxy, certain mistakes can undermine its effectiveness:

Delaying Creation Until You're Older or Sick

Many people assume healthcare proxies are only for the elderly or seriously ill. This is a dangerous misconception. Accidents, sudden illnesses, and unexpected complications can affect anyone at any age. Terri Schiavo was only 26 when she became incapacitated.

The time to create a healthcare proxy is while you're healthy and can thoughtfully consider your choices. Waiting until you're facing a medical crisis may mean you've waited too long—by then, you may already lack the mental capacity to execute legal documents.

Failing to Discuss Your Wishes With Your Agent

Simply naming someone as your healthcare proxy without discussing your wishes with them leaves them unprepared for the responsibility. Your agent needs to understand your values, your fears, your priorities regarding quality of life, and your preferences for specific treatments.

These conversations can be uncomfortable, but they're essential. Discuss scenarios like prolonged unconsciousness, terminal illness, severe cognitive impairment, and chronic pain. Talk about your spiritual or religious beliefs and how they might influence medical decisions. The more your agent understands your perspective, the better equipped they'll be to speak for you.

Not Updating Your Healthcare Proxy

Your healthcare proxy should be reviewed and potentially updated whenever you experience major life changes:

• Marriage, divorce, or widowhood

• Birth or adoption of children

• Death or disability of your designated agent

• Significant changes in your health status

• Estrangement from family members

• Changes in your values or medical preferences

A healthcare proxy you created 20 years ago may no longer reflect your current wishes or circumstances. Regular review ensures your document remains relevant and effective.

Choosing the Wrong Person Due to Obligation

Family pressure or a sense of obligation sometimes leads people to name someone as their healthcare agent who isn't actually the best choice. This can happen when adult children automatically designate their eldest child, when spouses name each other despite knowing their partner struggles with medical decisions, or when cultural expectations override practical considerations.

Remember: Designating a healthcare proxy is not an honor or a gift. It's a critical responsibility. Choose based on capability and suitability for the role, not obligation or tradition.### Keeping Your Healthcare Proxy Secret

Some people create healthcare proxies but don't tell anyone—even their designated agent—because they're uncomfortable discussing end-of-life issues or don't want to burden family members. This defeats the entire purpose of the document.

Your healthcare proxy is only effective if relevant people know about it and can access it when needed. Your agent can't act on your behalf if they don't know they've been designated. Medical providers can't honor your agent's authority if they don't know the document exists.

How Healthcare Proxies Integrate With Medicaid Planning

For middle-income Brooklyn families, healthcare proxies take on additional importance in the context of Medicaid planning and long-term care. The intersection of these issues requires careful consideration.

Long-Term Care Decision-Making

As families face the possibility of nursing home care or other long-term care arrangements for aging parents, the healthcare proxy becomes crucial for making decisions about placement, treatment, and care quality. The designated agent can:

• Evaluate different long-term care facilities and select appropriate placement

• Make decisions about the level of medical intervention desired in a care facility

• Authorize or refuse specific treatments or therapies

• Advocate for quality care and address concerns with facility staff

These decisions often occur simultaneously with Medicaid planning efforts to protect family assets while qualifying for benefits. Your healthcare agent and your financial power of attorney (who may be the same person) need to work together, as healthcare decisions can have financial implications and vice versa.

Coordinating With Irrevocable Trusts and Asset Protection

Families who've implemented asset protection strategies, such as irrevocable trusts, should ensure their healthcare proxy is coordinated with these arrangements. For example, if assets have been transferred to a Medicaid Asset Protection Trust, the healthcare agent needs to understand that they cannot use these assets to pay for care, as doing so could jeopardize the protection strategy.

Similarly, if the healthcare proxy is making decisions about long-term care placement, they should consult with the family's estate planning attorney to ensure the choices don't inadvertently affect Medicaid eligibility or asset protection plans.

HIPAA Authorization for Family Caregivers

When adult children are caregiving for aging parents, the healthcare proxy's built-in HIPAA authorization becomes critically important. It allows caregivers to communicate directly with medical providers, coordinate care among multiple specialists, and access medical records needed for Medicaid applications and care planning.

Without this authorization, even adult children who are actively involved in their parent's care may find themselves unable to get basic medical information, creating frustration and potentially dangerous gaps in care coordination.

Moving Forward: Taking Action to Protect Your Family

Understanding the importance of a healthcare proxy is only the first step. The true value comes from taking action to create, properly execute, and maintain this essential document as part of your comprehensive estate plan.

For Brooklyn families, the healthcare proxy provides peace of mind that extends far beyond the legal document itself. It represents a thoughtful, loving act of planning that protects your family from having to make painful decisions without guidance, prevents conflicts during times of crisis, and ensures your voice is heard even when you cannot speak.

Why Work With an Experienced Estate Planning Attorney

While basic healthcare proxy forms are available online and from the New York State Department of Health, the most effective healthcare planning happens in the context of comprehensive estate planning that addresses your unique family situation.

Alatsas Law Firm has been helping Brooklyn families with estate planning and elder law matters since 1996, with a deep understanding of the cultural, financial, and familial dynamics that affect middle-income families in Brooklyn, Queens, and Staten Island. When you work with our firm to create a healthcare proxy, it's part of a larger conversation about protecting your family's future, preserving your legacy, and ensuring your wishes are honored in all circumstances.

We help you think through the difficult questions that many people prefer to avoid, guide you in having important conversations with family members, and ensure all your legal documents work together seamlessly to provide comprehensive protection. Most importantly, we help you understand not just what each document does, but why it matters for your specific situation.

The Broader Estate Planning Picture

A healthcare proxy is one essential component of a complete estate plan that should also include:

• Last Will and Testament: Directing distribution of assets after death and naming guardians for minor children

• Revocable Living Trust: Avoiding probate and providing privacy for asset distribution

• Financial Power of Attorney: Authorizing someone to manage financial matters during incapacity

• Living Will or Advance Directive: Providing specific guidance about end-of-life medical preferences

• HIPAA Authorization: Ensuring family members can access medical information when needed

• Medicaid Planning Documents: Protecting assets while preserving eligibility for long-term care benefits

Together, these documents create a comprehensive safety net that protects you during life and provides for your family after death. Each document has a specific purpose, and when properly coordinated, they work together to address virtually any situation that might arise.

Start the Conversation Today

The most challenging part of creating a healthcare proxy isn't the legal process—it's the emotional hurdle of confronting our own mortality and vulnerability. These are uncomfortable topics that many families avoid discussing until crisis forces the conversation.

But here's the reality: The time to have these conversations is when you're healthy, clear-minded, and able to make thoughtful decisions. Waiting until a crisis occurs is waiting too long.

Start by thinking about who in your life demonstrates the qualities needed in a healthcare agent. Then, have an honest conversation with that person about your values, your fears, and your preferences. These discussions, while sometimes difficult, often bring families closer together and provide profound peace of mind.

Next, consult with an experienced estate planning attorney who can help you formalize your wishes in legally enforceable documents, ensure everything is properly executed, and integrate your healthcare planning with your broader financial and legacy goals.

Conclusion: Your Voice, Your Choice, Your Legacy

At its core, a healthcare proxy is about preserving the most fundamental human right: the right to make decisions about your own body and your own medical care. When illness or injury temporarily or permanently robs you of the ability to communicate, your healthcare proxy becomes your voice, ensuring that the medical care you receive aligns with your values, your beliefs, and your wishes.

For Brooklyn families who've worked hard to build financial security, own homes, and create stable lives for their children, the healthcare proxy is as important as any will or trust. It's the document that protects your autonomy, preserves your dignity, and spares your family from agonizing uncertainty during the most difficult moments of their lives. The cases of Terri Schiavo, countless families torn apart by medical disputes, and loved ones left to guess at the wishes of someone they cherish all demonstrate the same truth: Failing to create a healthcare proxy doesn't mean medical decisions won't be made—it just means you won't have any say in who makes them or what choices they make.

Don't leave your family to navigate these challenges without guidance. Don't risk a situation where the courts or strangers make intimate medical decisions for you. And don't assume you have plenty of time to address these issues later.

Take action today to create a comprehensive estate plan that includes a thoughtfully considered healthcare proxy. Have the difficult conversations with your loved ones. Designate someone you trust to be your voice. And give your family the greatest gift you can offer: the peace of mind that comes from knowing your wishes will be honored and they won't be left to struggle with impossible decisions during an already heartbreaking time.

Your future self—and your family—will be grateful you had the courage and foresight to plan ahead.