I once worked with the family of a successful executive from Manhattan who suffered a stroke without warning. Her daughter had a durable Power of Attorney, which we had prepared a few years prior. She could pay her mother’s mortgage, manage her investment portfolio, and keep her business affairs in order. But when she arrived at the hospital, the doctors would not speak with her. They asked for a Health Care Proxy, and her mother had never signed one. The family could access every dollar she owned, yet had no legal standing to make a single decision about her medical care.
This family’s story is a stark reminder of a common and dangerous misunderstanding. A Power of Attorney and a Health Care Proxy are both tools for delegating authority, but they govern entirely separate domains of your life. One protects your property; the other protects your person. Appointing agents to act in these roles is one of the most fundamental acts of stewardship in an estate plan.
Your Financial Custodian: The Power of Attorney
A Power of Attorney (POA) is a document where you, the principal, grant authority to an agent to act on your behalf in financial and legal matters. This is not a vague permission slip. In New York, the statutory short form Power of Attorney—governed by General Obligations Law Article 5, Title 15—lists specific powers you can grant, from real estate transactions and banking to managing business interests and filing taxes. You decide how broad or limited that authority will be.
The agent you name becomes your fiduciary. That term has real teeth. It means they have a legal duty to act in your best interest, avoid conflicts of interest, and keep meticulous records. This is a role that requires diligence, organization, and absolute integrity. Your agent could be paying your bills, selling property, or interacting with the IRS. This is the person you trust to manage your financial legacy when you cannot.
Crucially, their power ends where medical decisions begin. Your POA agent cannot consent to a medical procedure, speak to your doctors on your behalf, or make any choices about your physical care. For that, you need a different document and, quite possibly, a different person.
Your Medical Advocate: The Health Care Proxy
The Health Care Proxy is your voice for all medical decisions when you are unable to speak for yourself. The person you appoint as your agent becomes your advocate in the hospital room. They are empowered to make choices about treatments, surgeries, medication, and, if necessary, end-of-life care.
This is an immense responsibility. Your health care agent should be someone who understands your values, is not afraid to ask doctors hard questions, and can remain level-headed in a crisis. Their job is not to impose their own wishes, but to make the decisions they believe you would have made. This is why we often draft a Living Will alongside the Health Care Proxy—not to appoint an agent, but to provide written guidance on your wishes regarding life-sustaining treatment, which can be invaluable for your agent.
Think about the qualities required for this role. It is less about financial acumen and more about emotional strength and clear communication. The person who is best at managing a spreadsheet might not be the person best equipped to handle a complex medical diagnosis and advocate for your wishes under pressure.
Should They Be the Same Person?
Many clients initially assume they should name the same person for both roles—often a spouse or their eldest child. This can work, but it is not always the most prudent choice. The skill sets for a financial agent and a healthcare agent are profoundly different. One manages assets; the other manages your physical well-being.
I often ask clients to consider a simple contingency. Imagine your two agents—one for finance, one for health—disagree on a course of action. For instance, your health care agent wants to authorize an expensive experimental treatment, but your financial agent is concerned about depleting the estate. This tension is not necessarily a bad thing. It can create a system of checks and balances, forcing a conversation that fully considers both your health and your financial stewardship.
There is no single right answer. The goal is to be deliberate. Your financial agent should be chosen for their integrity and financial sense. Your health care agent should be chosen for their judgment, ability to handle stress, and intimate understanding of your personal values. Sometimes that is one person. Often, it is not.
Before you make a final decision on your agents, I recommend a simple exercise. Take a piece of paper and create two columns: “My Finances” and “My Health.” Under each, write the name of the person you believe is best suited to be the custodian of that part of your life. If the same name appears in both columns, pause and ask why. If the names are different, you are already thinking like a steward of your own legacy. When you are ready, we can schedule a meeting to review your choices and formalize your plan.
