Medical Decision-Making: Basic facts & Beginning the conversation
Many families worry about how to begin a discussion about medical decisions, living wills, and durable power of attorneys. It can seem awkward to start out of the blue: "Mom, do you and Dad have a Durable Power of Attorney for Health Care to make your medical decisions if you become incapacitated?" Many seniors hesitate to bring up the subject to their spouses or children, concerned they will worry or misunderstand the request. Sometimes people feel it is bad luck to bring up the topic, as if mentioning the topic will hasten one's death, or give the idea that they are close to dying. And yet, conversations about these matters are essential, even life-saving. Having the conversation before a crisis can prevent or alleviate family division after the fact.
Without advance planning, an unexpected injury or illness can result in unintended consequences, such as: an elderly or mentally fragile spouse becoming overwhelmed with sudden caregiving responsibilities, siblings pitted against one another on care and treatment choices. Family members may also have differing opinions on the use of aggressive treatment vs. hospice or palliative care, and the timing for each. Choosing a health care proxy you trust avoids this kind of inter-family division and heartache, which simplifies decision-making.
No matter where a person is in the various stages of illness, a physician, hospital, or nursing home may ask for a copy of the patient's Advance Directive and/or Durable Power of Attorney for Health Care. Of the two, a Durable Power of Attorney for Health Care is deemed by many to be a better vehicle than a Living Will. Living Wills, unfortunately, can over simplify or generalize on treatment because they are guessing what will be needed in advance of the situation.
No one can anticipate with any accuracy what medical decisions will need to be made and how the surrounding circumstances of the person at the time will affect those decisions. You are better off having someone you know and trust advocate for you when the question of treatment arises.
Choosing a person whom you trust to advocate for you as a health care proxy is a key element in the process. Ideally, the person should be strong enough to serve the advocacy role in the midst of today's chaotic health care climate. It might be better to choose an adult child, niece, or nephew, rather than an elderly spouse or sibling. They should be willing to ask questions and press for answers, making certain that pain is adequately controlled, food and water are given, unless determined to be harmful and/or unhelpful, and assisted suicide or death hastening medications or treatments are not implemented. Elderly or frail spouses, or elderly siblings, might experience physical or psychological distress, even anticipatory grief, that can be immobilizing and prevent effective advocacy.
In summary, choose a health care proxy well before you actually need one. Discuss with him or her what your general wishes are. If in agreement, ask if he or she is willing to serve as a health care advocate should you become unable to speak or advocate for yourself. Be sure to correctly fill out and meet whatever legal requirements there may be (i.e., notarize the document, should local or state statutes require this) on a Durable Power of Attorney for Health Care form and then copy the document, making certain that you, your health care proxy, and your physician all have a copy or know where to find one. In some states (Washington state included), you may indicate additional back-up proxies in case one is unavailable at the time. Check state regulations, probably located on the state's Department of Health website, or possibly the website for the state's Attorney General.
Eileen Geller, 2009
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