Indiana Health Care Representative: Who Can Serve and How to Appoint One

Indiana uses the term "Health Care Representative" where other states say "healthcare proxy" or "healthcare agent." The terminology matters because it reflects the specific legal framework created by Senate Enrolled Act 204 — the 2021 law that unified Indiana's previously fragmented healthcare planning system.

Your HCR is the single person authorized to make medical decisions on your behalf when you cannot communicate. Choosing the right person and documenting the appointment correctly determines whether your wishes are followed or ignored during a medical crisis.

Who Qualifies as an HCR in Indiana

Any competent adult can serve. Indiana law imposes no specific professional qualifications, no residency requirement, and no restriction based on relationship. You can appoint your spouse, an adult child, a sibling, a close friend, a neighbor, or even a professional patient advocate.

The practical question is not who is legally eligible but who will actually follow through. Your HCR needs to be someone who:

• Understands your values about medical treatment and quality of life
• Can handle high-pressure conversations with physicians
• Is geographically accessible or reachable quickly
• Will not cave to family pressure that contradicts your wishes
• Is willing to make difficult decisions, including authorizing withdrawal of treatment

You should also name at least one alternate. If your primary representative is traveling, ill, or simply unreachable when the hospital calls, having a backup prevents your decisions from defaulting to the statutory family hierarchy.

How the Appointment Works

The HCR appointment is part of your advance directive under Indiana Code § 16-36-7. You cannot appoint an HCR through a standalone letter or a general power of attorney — it must be included in a properly executed advance directive that is written, dated, signed, and witnessed or notarized.

In your directive, you specify:

• Primary HCR — full name, phone number, relationship
• Alternate HCR(s) — in order of succession
• Scope of authority — whether the HCR can act immediately or only after a physician certifies incapacity
• Limitations — any specific treatments you do or do not want the HCR to authorize

Your HCR's authority is subordinate to your own while you retain capacity. They only step in when your attending physician certifies in writing that you cannot make or communicate treatment decisions.

The Standard of Conduct

Indiana law holds your HCR to a specific legal standard. They must act in good faith and attempt to make the exact decisions you would have made under the circumstances. This means following your known preferences — whether expressed in your advance directive, in prior conversations, or through your values and life patterns.

If your wishes are completely unknown, the HCR must default to acting in your objective best interests. This is why specificity in your advance directive matters — the more detail you provide about your treatment preferences, the less your representative has to guess.

When You Do Not Name Anyone

Without a designated HCR, Indiana's default consent hierarchy under IC § 16-36-1-5 determines who makes your medical decisions. The hierarchy starts with a court-appointed guardian, then your spouse, then a majority of your adult children, and continues down through parents, siblings, and grandparents.

The problem is not that this hierarchy exists — it is that it operates by majority vote at each tier. If you have three adult children and two disagree about continuing life support, the two-to-one majority controls. Family dynamics, old grudges, and conflicting beliefs about end-of-life care turn this default system into exactly the kind of stalemate most people want to prevent.

A separated spouse or one with a pending divorce petition is automatically disqualified. Anyone subject to a protective order or facing criminal charges where you are the alleged victim is also barred from making your decisions.

Appointing an HCR bypasses this entire system and puts one person you trust in charge.

The Indiana Advance Directive & Living Will Kit includes the HCR appointment with authority scope templates and a witness eligibility checklist to ensure valid execution.

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