As hospitals across the country have started pushing more and more for patients to complete advance directive forms it may seem we are making progress in addressing end of life wishes.  One key problem remains however; many people are filling out these forms without solid guidance on how to do so.  Making uniformed choices in this paperwork can lead to the exact opposite of the intended goal.  
One of the simplest and potentially most effective acts in establishing and furthering your end of life wishes is choosing a Durable Medical Power of Attorney.  (Also called medical power of attorney or medical proxy).  This portion of an advanced directive establishes the person or people named to make health care decisions for you should you ever are unable to make those choices yourself.    While the choice may seem obvious for you on first glance, I encourage you to consider these points before making a choice.   
If you do not designate a medical power of attorney through appropriate channels and documentation then the following people will be responsible for your medical care decisions in the event you are unable to make your own choices (in order of priority).
             -A previously appointed court guardian or conservator
             -Your current spouse or domestic partner
             -Your Adult Child
             -Your Adult Sibling
             -A close friend or your nearest living relative
*Your Agent Should Be Someone You Can Trust With Your Life – because you are trusting them with your life.
* Choose someone that meets the local requirements to act as an agent.  Each state has varying restrictions and requirements.  You can look at your local requirements here. 
*Your agent should be over 18 years of age.
*Your agent should be an adult of sound mind who will be available to make decisions on your behalf should it become necessary.    This person should live near you or be able to travel to be with you if necessary.  
*Your agent should be someone who can handle conflicting opinions from family members, friends and medical personnel, they should be able to be a strong advocate for your wishes and you should be able to talk to them now about your wishes and be sure they respect them and will follow them.
*Choosing your children, parents or spouse, at face value seems like a great idea, these are often the people that are closest to you and have a vested interest in perpetuating your end of life wishes.   They are however, likely to be the most conflicted and emotionally distraught in the event of an emergency that leaves you unable to make your own choices.  Furthermore one of these people having the medical power of attorney may cause a rift between them and other family members, or their loyalty and consideration of other family members may make it more difficult for them to make the decisions that honor your wishes.  
*Naming a member of your healthcare team, residential care facility that is currently serving you, or any of their family members will often make them ineligible to act as your proxy due to conflict of interest. 
*Naming multiple agents may seem logical but if those agents do not agree it may be more difficult to have your wishes honored.  If you choose to have multiple agents listed, each agent should be carefully considered.  
Once you have decided on a Durable Medical Power of Attorney – it is necessary to make sure you complete necessary paperwork and legal process to make sure it is honored.  Furthermore, it is necessary to make sure that you communicate to the chosen person that you have designated them and have discussions with them about your wishes.  It is preferable that your wishes are expressed both verbally to your agent and in writing (such as in an Advanced Care Directive).  Your agent, as long as they act in good faith to make your wishes known and followed, is not legally liable for the choices made, however, if they do not have the appropriate knowledge of your wishes it is difficult, if not impossible, for them to ensure that you receive the type of care you would choose to receive.