When Patient Advocacy Meets Healthcare Surrogacy / Healthcare Proxy: Where Do We Draw the Line?

I'd love to start a conversation with fellow advocates about an important consideration in professional patient advocacy: serving as both an advocate and a legally designated healthcare decision-maker.

Through Peace of Mind Care Visits, I provide patient advocacy, healthcare navigation, and professional healthcare surrogacy services. These roles can complement one another, but they also come with distinct responsibilities and professional boundaries.

In Florida, we use the term Healthcare Surrogate, while other states may use Healthcare Proxy or Healthcare Agent. Although terminology and legal requirements vary, the underlying responsibility is similar: making authorized healthcare decisions on behalf of someone who cannot make those decisions themselves.

So how do we navigate providing both services to the same client?

My approach begins with clearly distinguishing the two roles.

While a client has decision-making capacity, my responsibility as an advocate is to educate, support, communicate, and help them navigate their healthcare options. The decisions remain theirs.

When a client lacks decision-making capacity and the legal requirements for exercising surrogate authority are met, my role changes. I may then be responsible for making healthcare decisions based on their known wishes, values, and applicable law.

I believe it's important to establish expectations early, document healthcare preferences, maintain clear professional boundaries, and recognize potential conflicts of interest.

But there are some interesting questions worth exploring.

How do we separate advocacy from surrogate decision-making when we're serving the same individual in both capacities? How do we handle disagreements with family members or healthcare providers? And what safeguards should we have in place to protect both the individual and the advocate?

I'd love to hear from other advocates:

Would you accept both roles for the same client? If you already provide healthcare surrogacy or healthcare proxy services, how do you structure those relationships, document decisions, and manage potential conflicts of interest?

I think this is an important conversation as professional advocacy continues to evolve, and I'd love to learn how others approach it.