(from Carolyn McClanahan’s Forbes’ column, 5/22/2012 – click here for the original post. Carolyn is a physician, financial planner, educator and storyteller. For more on Carolyn, visit her Forbes’ profile.)
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.
Move up https://i.forbesimg.com tMany 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.
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.