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Step 4: Put your choices in writing |
New York State law is designed to make sure your wishes for care are respected. The New York Health Care Proxy law permits you to name another person to make health care decisions if you are no longer able to make decisions. These decisions apply to all health care treatments including services and procedures to diagnose or treat any physical or mental condition.
Use the NYS Health Care Proxy form (click to download) to name the person who will serve as your health care agent. Your agent will start making decisions only if your doctors decide you are not able to make health care decisions yourself.
You may include the names of one or more people as alternate agents. If you like, you may also add instructions for your health care agent to help make future health care decisions. Also, if you wish to limit your agent's authority in any way, you should say so here. If you do not state any limitations, your agent will be allowed to make all health care decisions that you could have made, including the decision to consent to or refuse life-sustaining treatment.
It is especially important to discuss and write down your wishes about artificial nutrition (being fed through a tube) and artificial hydration (providing water through a tube). If this is not stated, your agent will not have the authority to make decisions about them.
Talk to your doctor if you have questions about your medical condition and possible treatments. You can make a very specific statement about your care wishes including specific instructions for different situations, or you can simply state:
"I have discussed my wishes and preferences with my health care agent and alternate, and they know my wishes including those about artificial nutrition and hydration."
When the form is complete, two adults need to sign the form as your witnesses under the note that says you appear to have completed this form willingly. Neither your health care agent nor your alternate can sign as a witness. You do not need a lawyer or notary for your form to be legal.
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Important Information |
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Interested in more specific instructions?
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Filling Out the Proxy Form
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Advance Directives
