We have all
heard the stories – accidents, sudden illness, or slow decline taking away a
person’s capacity to make their health care decisions. Unfortunately, few
people have taken the time to appoint someone as health care surrogate to act
on their behalf in these situations and only a handful of people have discussed
their wishes with their surrogate. Today I discuss how to pick your health care
surrogate – it definitely requires some thought.
What does a
“health care surrogate” do? Basically, they make your health care decisions if
you are incapacitated and can’t make decisions for yourself. Note – you have to
be both incapacitated and unable to make decisions. For those who have a hard
time making decisions, you can’t punt your healthcare decisions to someone else
just because multiple choices paralyze you.
Many people
think a health care surrogate acts only at the end of life, but there are many
situations that are not necessarily life threatening where your wishes may need
to be shared by someone else. If an accident takes away your ability to
communicate, your health care surrogate will need to step up to speak for you
and they must be willing and able to do this at a moment’s notice.
What are the
qualities of a good health care surrogate?
The health care
surrogate must be a level-headed individual:
If you sustain
a severe head and neck injury, and the doctor tells your spouse that despite
best efforts, you will never be able to feed yourself or engage in a
conversation ever again, what will your spouse do? Will he freak out and want
to keep you alive forever in the hope of a miracle when you’ve explicitly
stated that you do not believe in miracles? A spouse does not always make the
best health care surrogate. Be certain to choose someone who can follow your
wishes and make good decisions in light of heart wrenching emotions. For this
reason, the role of health care surrogate may be best delegated to a health
care professional within the family.
The health care
surrogate cannot be shy about asking questions and must be intelligent enough
to understand the implications of the answers:
To fulfill this
responsibility, your surrogate must understand your goals. Every treatment the
health care providers want to perform must reach the eventual outcome of the
goals you’ve shared with your surrogate. For me, it is so important to always
have the use of my brain and my hands. If I am in a situation where we know I
have a good chance of those two functions being restored, do everything toward
achieving that outcome. If it is obvious that my brain will no longer allow me
to write this blog or have my fabulously self deprecating sense of humor, the
only things I want done are comfort measures to let me die quickly. Your
surrogate must constantly ask, “Will this help my loved one reach the goals of
_________.”
The health care
surrogate must be willing to stand up to the health care system:
The health care
system is wired to “DO EVERYTHING!” Our malpractice and payer systems greatly
affect how medicine is practiced. High pressure situations lead to high
pressure heroics, especially if doctors do not have a previous relationship
with you. It is in the provider’s best interest to do everything possible until
your health care surrogate has screamed, “ENOUGH!” If you have been clear in
your wishes to limit care in certain situations, your health care surrogate
will have to be vocal and not easily intimidated by overbearing health care
professionals. For example, if the doctor says you will die if they do not
place a feeding tube into your abdomen, and it has already been determined that
your desired ability to recognize your loved ones is not in the cards ever again,
will your health care surrogate have the fortitude to say no to their request?
The health care
surrogate should live in close proximity if possible and have the time to
address your urgent situation:
Ideally, the
likelihood of needing your health care surrogate is small. However, someone who
lives across the country may not be in the position to uproot their life to
address your health care needs.
Other
considerations:
In addition to
your primary health care surrogate, it is good to have one or two backups. Ask
their permission in advance, and share a written copy of your health care goals
with them. Share your decision on who is serving as surrogate with other family
members, and let the entire family know you have written clear wishes that are
not to be messed with. The biggest impediment to a successful outcome is to
have other family members not on board with your desires. When multiple family
members question decisions of your health care surrogate, angst results. Your
surrogate has a difficult enough job without the added burden.
I wish us all a
quick, painless, and planned for death at about age 100, but unless you plan on
riding your Vespa off a cliff, planned death is unlikely. Therefore, choose
your health surrogate wisely just in case you need to visit that topic sooner
than you desire.
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