Health Care Proxy in Maine

What a Health Care Proxy Is in Maine

A health care proxy — called a "health care agent" under Maine law — is a person you legally designate to make medical decisions on your behalf when you can't make them yourself. In Maine, the document that creates this authority is the Advance Health Care Directive, governed by the Maine Revised Statutes Title 18-C.

The agent's authority activates only when the principal (your parent) is determined by the primary physician to lack the capacity to understand and make their own health care decisions, unless the directive specifies otherwise. Until that determination, the agent has no authority — your parent remains in full control of their own medical care.

How It Differs From a Power of Attorney

This is where families get confused. Maine law recognizes two distinct types of legal authority, and they cover different domains:

A health care agent (via the Advance Health Care Directive) makes medical decisions — consenting to or refusing treatment, choosing between care options, selecting a facility, and making end-of-life decisions consistent with the principal's stated wishes.

A durable power of attorney (under the Maine Uniform Power of Attorney Act, Title 18-C, Article 5, Part 9) handles financial and legal matters — managing bank accounts, paying bills, selling property, applying for benefits like MaineCare.

Having one does not give you the other. A family member with financial power of attorney cannot consent to surgery or refuse a feeding tube. And a health care agent cannot access a parent's bank account to pay the nursing home bill. Most families need both documents in place before a care crisis hits.

Executing a Valid Directive in Maine

Maine's Advance Health Care Directive form allows a person to both appoint a health care agent and document their wishes about end-of-life treatment. The Maine Office of the Attorney General publishes the statutory form.

To be legally valid, the directive must be in writing and signed by the principal and two witnesses in person. Notarization isn't required under this provision, although many families have the document notarized anyway to reduce the chance of challenges from medical providers unfamiliar with the form.

The principal must have cognitive capacity at the time of signing. They need to understand what the document does, who they're appointing, and the scope of authority they're granting. If your parent already has significant cognitive decline — a moderate-stage Alzheimer's diagnosis, for example — the window to execute a valid directive may have already closed.

What to Include Beyond the Agent Appointment

The directive should spell out specific preferences that guide the agent's decisions. Vague language like "do what you think is best" leaves the agent guessing during exactly the moments when guessing is hardest.

Specific areas to address: preferences about mechanical ventilation, artificial nutrition and hydration, resuscitation, and comfort care in a terminal condition. Whether the parent would want to be transferred to a hospital from a nursing facility or receive comfort care in place. Whether they want aggressive treatment of infections in late-stage dementia or a palliative approach.

Many families also include preferences about the care setting itself — whether the parent would rather receive care at home as long as possible, or transition to a facility when in-home care becomes unsafe. These preferences don't create legal mandates, but they give the health care agent a documented framework for making placement decisions.

When No Directive Exists

If your parent loses cognitive capacity without having executed a health care directive, the family faces a significantly harder path. Without a designated agent, medical providers must follow Maine's default surrogate decision-making hierarchy.

Under Maine law, medical providers can accept consent from the following people, in priority order: the patient's court-appointed guardian (if one exists), the patient's spouse or an adult in a spouse-like relationship, an adult child, a parent, an adult sibling, an adult grandchild, an adult niece or nephew, an adult aunt or uncle, or another adult relative familiar with the patient's values; if none is reasonably available, an adult who has exhibited special care and concern for the patient.

When there's only one adult child involved, the hierarchy works reasonably well. When there are multiple siblings who disagree about treatment decisions — one wants aggressive intervention, another wants comfort care — the hierarchy creates conflict that the medical team cannot resolve.

In those situations, the family may need to petition the county probate court for appointment of a guardian with authority over health care decisions. That process can take time, costs $90 in filing fees for a guardianship petition (or $115 for a joined guardianship and conservatorship petition), and generally requires a court hearing. In an urgent situation, ask the probate court about emergency protective procedures while the regular petition is pending.

Health Care Agents and Care Transitions

The health care agent's role becomes especially important during care transitions — the move from hospital to skilled nursing facility, from home to assisted living, or from assisted living to a higher level of care.

When a parent is transferred from a hospital to a nursing facility, the receiving facility requires consent from someone with legal authority. When a nursing facility proposes to change a resident's level of care or issue an involuntary transfer, the health care agent has the right to participate in care planning meetings, review the medical justification, and appeal the decision through the Maine Long-Term Care Ombudsman Program.

During the Maximus clinical assessment that determines eligibility for MaineCare long-term care benefits, the health care agent can attend the interview, provide additional information about the parent's functional limitations, and ensure that the assessor has a complete picture of daily care needs — something that matters enormously when a parent tends to minimize their own limitations during evaluations.

If your parent is entering the phase of life where care decisions are becoming necessary, getting both a health care directive and a durable power of attorney executed now — while capacity exists — is the single most important step you can take. Everything that follows becomes easier with those documents in place.

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