In Colorado, no one is given automatic authority in decision making for another adult, and healthcare providers cannot simply make decisions for individuals except in an emergency.
- “Next of kin,” spouses, adult children, or other relatives are not authorized decision makers unless duly appointed as a Healthcare Agent or Guardian.
- If an individual does not have a Healthcare Agent under Medical Durable Power of Attorney or Guardian, and if that individual is unable to make or express decisions, a “Proxy-by-statute” is needed.
- First, the individual’s physician “certifies” that the individual does not have capacity to make his or her own decisions. As of January 1, 2009, Advanced Practice Nurses (APN) may also make this determination about an individual in collaboration with the attending physician. Such collaboration may be done in person, by phone, or electronically. The nurse must document the name of the physician with whom she or he collaborated.
- Next, the physician, APN, or someone designated by the physician or APN must make a good faith effort to locate and assemble (physically or via communication technology) people who have an interest in the care of the individual who is ill.
- These “interested parties” – which can be family members by blood, marriage, or adoption; life partners; close friends; pastoral or other advisors – determine by consensus which one of their group will serve as the “Proxy” for the individual.
- Once the Proxy is selected, the physician or APN documents the name and contact information for the Proxy in the medical chart. The individual must also be informed of the choice of Proxy.
- If the group can’t agree on who the Proxy should be, then guardianship must be pursued through the courts.
- Like a Healthcare Agent, the Proxy should act according to the known wishes and values of the individual; so the Proxy should know the individual well and, if possible, have a clear understanding of his or her wishes and values and how they might affect medical treatment decisions
- Proxies selected in this way cannot withhold or withdraw artificial nutrition and hydration for the individual, unless two physicians (one trained in neurology) determine that the treatment is only serving to prolong the individual’s death.
- The Proxy-by-statute process is intended as a stop-gap in unexpected circumstances or for a particular episode of care. Proxy-by-statute decision makers are not intended to remain in the role indefinitely. If the individual requires long-term medical decision making, an interested person should seek Guardianship through the courts.