Healthcare Agents and Medical Decisions

Originally written in September 2010

I encourage all of my clients to consider signing a healthcare power of attorney. This document gives broad powers to someone you trust, such as a spouse, sibling, or close friend, to make healthcare decisions on your behalf if you are ever unable to make such decisions for yourself.

However, how do you know that your healthcare agent has the same values and beliefs regarding end of life issues as you do? It is important that you communicate your desires regarding medical circumstances and end-of-life issues to your healthcare agent(s). This can be either in writing or through verbal instruction.

As you think through your wishes, some important questions to consider are:

• How do you define your own quality of life?
• What fears or concerns do you have regarding end of life issues?
• If you were terminally ill, how would you like to spend your last days or weeks?
• Would you want everything possible to be done to prolong your life? Or do you not wish to prolong the process of dying?

You are advised to state your desires (either orally or in writing) about the goals and types of medical care you do or do not want, including your desires concerning life support if you are seriously ill. If your wishes are not known, your healthcare agent will make the best choice possible in his/her opinion considering your personal values.

I have given the following definitions and scenarios, as a beginning point for you to consider exactly what type of care you would or would not like to receive in the event of serious illness.

Regarding Life Support

Life support or life-sustaining treatments are any medical procedures, devices or medications used to keep you alive. Life support treatments may include: medical devices put in you to help you breath; food and fluid supplied artificially by medical device (feeding tube); cardiopulmonary resuscitation (CPR); major surgery; blood transfusions; kidney dialysis; and antibiotics.

People usually choose one of the following options:

If I am suffering from a terminal condition from which death is expected in a matter of months, or if I am suffering from an irreversible condition that renders me unable to make decisions for myself and life-support treatments are needed to keep me alive:

I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician(s) allows me to die as gently as possible;

or

I want my life to be prolonged as long as possible within the limits of generally accepted health care standards.

Scenarios to Consider

A. If you were in a coma or a persistent vegetative state and, in the opinion of your physicians, have no hope of regaining awareness and higher mental functions no matter what is done, would your goals and specific wishes, if medically reasonable, for this and any additional illness be to:

1. Prolong life; treat everything;
2. Attempt to cure, but reevaluate often;
3. Limit to less invasive and less burdensome interventions;
4. Provide comfort care only; or
5. Other

B. If you were near death and in a coma and, in the opinion of your physicians, have a small but uncertain chance of regaining higher mental functions, a somewhat greater chance of surviving with permanent mental and physical disability, and a much greater chance of not recovering at all, then would your goals and specific wishes, if medically reasonable, for this or any additional illness be to:

1. Prolong life; treat everything;
2. Attempt to cure, but reevaluate often;
3. Limit to less invasive and less burdensome interventions;
4. Provide comfort care only; or
5. Other

C. If you had a terminal illness with weeks to live, and your mind was not working well enough to make decisions for yourself, but you were sometimes awake and seem to have feelings, then would your goals and specific wishes, if medically reasonable, for this and any additional illness be to:

1. Prolong life; treat everything;
2. Attempt to cure, but reevaluate often;
3. Limit to less invasive and less burdensome interventions;
4. Provide comfort care only; or
5. Other

D. If you have brain damage or some brain disease that in the opinion of your physicians cannot be reversed and that makes you unable to think or have feelings, but you have no terminal illness, then would your goals and specific wishes, if medically reasonable, for this and any additional illness be to:

1. Prolong life; treat everything;
2. Attempt to cure, but reevaluate often;
3. Limit to less invasive and less burdensome interventions;
4. Provide comfort care only; or
5. Other

E. If you were in a good and alert state of health and then you had an illness that, in the opinion of your physicians, is life threatening but reversible, and you are temporarily unable to make decisions, then would your goals and specific wishes, if medically reasonable, be to:

1. Prolong life; treat everything;
2. Attempt to cure, but reevaluate often;
3. Limit to less invasive and less burdensome interventions;
4. Provide comfort care only; or
5. Other

Obviously, the above scenarios are not comprehensive, and we can never be 100% prepared for every possible medical situation. This information is designed to be a tool for you to think about and consider with your loved ones. It is important to continue to keep your healthcare agents informed of your current wishes. This can be verbally, or in the form of a written memorandum. It is also important to recognize that your wishes may change over time as the state of your health and mind change and as you and your loved ones encounter different medical circumstances. You should periodically ensure that your healthcare agents understand your most current wishes.

Additional Resources

“Finding Your Way” published by Center for Healthcare Decisions. www.chcd.org

“Hard Choices for Loving People” by Hank Dunn.  www.hardchoices.com