Health Care Proxies: Whom Do Young Old Adults Choose and Why?

Abstract

Dying persons are encouraged to name as durable power of attorney for health care (DPAHC) someone who will thus be empowered to make end-of-life treatment decisions for them in the event that they become incapacitated. We use data from the Wisconsin Longitudinal Study to investigate whether and whom older adults designate as their DPAHC. DPAHC appointments are affected by recent hospitalizations, personal beliefs (including religion, fear of death, and the belief that doctors rather than patients should control health care decisions), and personal experience with the recent painful death of a loved one. The selections of DPAHC designees are generally consistent with the hierarchical compensatory model: Married persons overwhelmingly name their spouses, while unmarried parents appoint their children. Women are more likely than men to rely on children. Parents of one or two children tend to bypass their children for another relative. Unmarried, childless persons show considerable heterogeneity in their choices. We discuss implications of these findings for health care policy and practice.