Choosing a Healthcare Surrogate (HCS) is imperative and should be done as early on as possible. Let me explain why. A HCS is going to be your voice making decisions about you if, and only when, you are unable to let others know what you want. I have had patients in situations where a sibling who had been estranged for years arrives to see you but is not allowed, a patient who was accepting of their decline and unresponsive end up with a feeding pump, family members arguing over care because no one has the authority to make the final decisions. If you are able to make decisions for yourself, then of course you will always have the final say. But because you and your doctor do not know the exact time if or when you may become confused, agitated, or unresponsive, having a HCS in place makes for a smooth transition. Without a HCS chosen by you, decisions are based upon what others would want, not necessarily what you would want for yourself. I once worked with a patient who had four adult children and had not chosen a HCS. Two of his children were from a previous marriage. His current wife did not want his other children to be consulted or updated on his imminent status, despite their having a relationship and been involved with their father during his illness. She did not want them called even when he died. Because he had no HCS, the doctors will look to the next of kin to make decisions, and his wife was making all decisions. Her own children were arguing to have him brought home to die instead of being at the hospice house. And when I say arguing, I mean loud shouting and tears at his bedside. But what did the patient want? An opposite scenario occurred with another patient of mine. This woman sat her children and husband down and said ‘this is what I want’, and when her daughter protested about her signing a DNR, Do Not Resuscitate, or her husband questioned her stopping her chemo treatment, she was able to explain her thinking and her reasoning for how she wanted to proceed. It was her son she chose as her HCS as he had defended and accepted her choices as hers to make whether or not they were choices he would have for himself. When I first met this patient she was unresponsive. As the doctor updated the family on her status, it was her son who made the decisions regarding her care after consulting with his sister and father. Her daughter told me after her mom’s death that having her brother be HCS made it easier on her. She did not want the burden of making decisions and she thought her dad would have just kept fighting for everything to be done, which is exactly what her mother did not want. ‘It took a lot of stress out of what was already a very stressful situation’.