Choosing who will choose: The Why and How of Selecting a Healthcare Agent

Wednesday, 30 May 2012 12:23

Will your cousin (who lives across the country) choose what you will have for lunch?

Did your mother choose which underwear you are wearing today?

All very unlikely -yet both of these relatives could end up choosing whether you
have a feeding tube placed in you, or whether you are kept alive on a ventilator in
a diaper at the end of your life.

This is sometimes the case when we haven't created advance directives, and
haven't spelled out in detail what we want or don't want, and haven't selected and educated a healthcare agent(s).

Beyond the obvious, there are two critical reasons that you should not allow the
medical decision making role to fall haphazardly to your closest or most demanding
family member should you become unable to make decisions for yourself:

1- Huge guilt burden:

If your poor mother or significant other is placed in the role of making
critical uninformed decisions for you in an end of life situation... they may
live out the rest of their own lives questioning their decisions. The guilt burden
created by unguided end of life medical decision making can be devastating (meaning no one had ever discussed or documented any wishes). Don't be a part of creating this type of emotional trauma for your family. Select your healthcare agent(s) ahead of time and educate them on your choices.

2- Unwanted heroic measures

If you haven't left advance directives and groomed a healthcare agent to carry out your wishes, you might end up receiving medical interventions you would have never wanted.

A "dominant personality" relative could show up at the hospital and demand that I do things to you that you would have found unacceptable, or a grieving loved one might ask for treatments that
could simply prolong your dying process/artificially extending your death-- thereby, creating or prolonging suffering for you.

I know that none of this sounds comforting. But, the good news is that these types of scenarios can be
avoided by selecting and educating healthcare agent(s) NOW.

Here is how! (excerpted from Chapter 8, "It's OK to Die™"):

A. Think about the following topics when choosing your healthcare agent(s):

• Do they have any medical knowledge?

• Are they willing to put your needs and desires before their own?

• Do you trust them?

• Does your extended family trust them?

• Do they have good leadership and decision-making skills?

• Would you trust them to take care of someone you love?

B. I recommend that you discuss the following topics with your selected healthcare agent(s):

• Outline your present level of health and quality of life. Use the Personal Self-Assessment Scale (PSAS) as a guide.

• Discuss your feelings about death, dying, and illness.

• What level of physical independence is important to you?

• What level of mental activity is important to you?

C. With your healthcare agent(s), discuss whether there is a level on the Personal Self-Assessment Scale after which you would NOT want these interventions:

• Surgical procedures

• Dialysis for kidney failure

• Feeding tube for artificial nutrition

• Blood transfusions

• Transfer to an acute care hospital

• Hydration with IVs

• Antibiotic treatment

• CPR or artificial life support

• Tell your healthcare agent(s) whether you have discussed these topics with any other family members and your physician. (If not, please do so.) Identify any additional family members you would like to have involved in any decision making processes.

(For more information on educating your healthcare agent(s), see Chapter 8 of "It's OK to Die™")

Monica Williams-Murphy, MD