There are some restrictions on the decisions a TSDM can make, compared to a representative. For example, a TSDM can only refuse life support on your behalf if the majority of the medical team agrees. With the Representation Agreement Section 9 (RA9), you can give your representative the final say. Your representative is likely going to know your wishes better than a hospital medical team that has not met you before.
Here’s a real life example to consider when deciding whether or not an RA9 is for you. Nidus was contacted recently by a representative for a friend who was in hospital due to illness. The friend used a respirator and the hospital staff exchanged her portable system for the hospital equipment. They also set the air mixture according to their standard measures. However, these were very different from the patient’s normal settings. The consequence was that the patient could no longer speak, which affected her ability to direct her own care. The staff did not ask anyone for consent about the respirator settings because from their perspective, they were following standard procedures. The representative knew her friend had made a Representation Agreement some time ago but could not locate it. Fortunately a copy was stored with the Nidus Personal Planning Registry and the representative was able to talk with the medical staff on her friend’s behalf to get changes made to the air mixture of her respirator. She would not have been able to do so as a TSDM because the health care professionals did not see a decision to be made.