Althea Halchuck speaker

Althea Halchuck, EJD, CT

In this video from the 2021 Before I Die New Mexico Festival, Althea Halchuck, EJD, CT, presented “Who Will Speak for You? Medical Surrogacy Questions Answered.”

During this presentation, you will learn why your husband or child might not be the best choice to make end-of-life decisions for you when you can’t. Learn what personality traits to look for in choosing an effective surrogate to ensure your end-of-life wishes are honored. Learn language to assert your authority to honor an advance directive and practical ways to ensure a peaceful death.

Althea is the founder of Ending Well! Patient Advocacy LLC. She has an extensive background in end-of-life care, including 15 years of involvement with hospice, seven years as a long-term care ombudsman in California, and she’s a practicing end-of-life doula and death educator. She earned an Executive Juris Doctorate degree in health law, and she is the Surrogate Consultant and Death Maven™ for the Final Exit Network (FEN: If a FEN member is having trouble enforcing an advance directive, they can call her and she will help them get through it. She also answers members questions on advance directives and living wills.

In this presentation, she provides tips on selecting an effective surrogate (it may not be the person you think) and ways to have your advance directive followed. She also provides a case study for a person who was having trouble enforcing an advance directive for a spouse.

“The key to having your healthcare wishes honored is choosing a surrogate who will speak for you and make sure your treatment wishes are followed,” said Halchuck. “Your surrogate is so critical to the success of your planning, it’s the first question on every advance directive. Who will your surrogate be? You want a bulldog.”

Watch the Video

Please accept YouTube cookies to play this video. By accepting you will be accessing content from YouTube, a service provided by an external third party.

YouTube privacy policy

If you accept this notice, your choice will be saved and the page will refresh.

Why Have an Advance Directive?

Poster Girls for Failing to Prepare: Karen Ann Quinlan, Nancy Cruzan, and Terri Schiavo were all in their 20s when they had medical episodes that put them in a persistent vegetative state without written guidance about whether they wanted to be kept alive under those conditions. This resulted in years of court fights, pain for their family members, and national news headlines. Don’t let this happen to you!

All advance directives are state-specific. They can include a living will, health care power of attorney, health care wishes, and medical decisions. All states offer free forms, but the low-cost Five Wishes Form is understandable, comprehensive, and legal in most states.

Once you’re incapacitated, it’s too late to make your wishes known. Advance medical directives can make the difference between living a good quality of life after a medical crisis and merely surviving.

Top 10 Traits for an Effective Medical Surrogate:

  1. Your wishes are paramount. This person will honor your wishes.
  2. They have the emotional strength to carry out end-of-life wishes.
  3. They are a strong communicator to medical staff and family members.
  4. They have an open mind and can be a good listener.
  5. They are deliberative and assertive about your medical care and won’t be bullied by medical staff – a warrior, not a wallflower.
  6. They are not afraid to ask questions.
  7. They will research medical conditions to learn what may best serve the patient’s wishes.
  8. They will ask for help if needed, feel ignored, overruled or outnumbered, can always ask for an ethics committee ruling.
  9. This is a person who will remain calm in a crisis.
  10. This is a person who is ready, willing and able to serve and carry out this job.

Not choosing is still making a choice. This may turn out not be the best person for your wishes. A distant relative can swoop in and make demands to “do everything.” The medical staff might name a person for you. “Pick before someone does it for you,” said Halchuck.

Talk about your expectations with your surrogate. Does the person have some flexibility to address some unforeseen issues for your benefit? You also want to have multiple conversations with your family, your surrogate, and your medical team if you can. At what point is life not worth living for you? When is comfort care preferred over aggressive treatment?

Review your advance directive every decade. So much can change during ten years!

The 5th annual Before I Die New Mexico Festival was held October 30 to November 2, 2021. The first two days of events were held in-person in Albuquerque October 30 & 31 with virtual access online. The second two days were primarily online November 1 & 2, with evening events in person.You can find this video and videos of other sessions from the Before I Die New Mexico Festival at

2021 Before I Die NM Festival and Video Sponsors2021 Before I Die Festival Sponsors

Thank you to these companies and organizations that made the Before I Die NM Festival possible.

A portion of the sponsorship proceeds and ticket sales from the Before I Die NM Festival were donated to 501(c)(3) charitable partner, Historic Fairview Cemetery, established in Albuquerque in 1881. The cemetery is the final resting place of 12,000 individuals, with remarkable stories reflecting the history of Albuquerque, New Mexico, and the United States of America. The website is