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To Surrogate or Not To Surrogate
by Jeffrey Loebl
So someone asks you to be his or her
health care surrogate. What should you think about and ask?
The forms are ubiquitous. Every time
someone is admitted to a hospital an Advance Health Care Directive form is
offered. Many state-specific versions are available on the Internet. Each of
these forms purports to give a signer's authority and guidance to another
person to carry out their wishes. (The
documents, at least in California, are really a power of attorney merged with a
living will combined with a Nomination of Conservator and a HIPPA release).
When agreeing to take on the task of
helping an incompetent person receive medical care, you should find out (assuming the person bothered to ask you
before just naming you as surrogate):
the person want her religion's health care requirements followed regardless whether
she has expressed conflicting opinions in the past? If the signer wants to strictly follow a
religion as to end of life care, it would be best to select a member of the
clergy of that religion. If someone desires to apply the dictates of a particular
religion as interpreted by a religious leader, I would decline to be the
the signer may choose to state a religious preference and that the religious
preferences be followed so long as they do not conflict with her stated wishes
and decisions of the surrogate. Language acknowledging religion, but not allowing
the religion to overpower individual desires, affords comfort and avoids
religious arguments at the time of difficult decisions.
Advance Healthcare Directives incorporate a separate form nominating a
conservator. If the list of conservators is not the same as the list of
surrogates, I would never want to serve as a surrogate and have to coordinate
with the conservator.
does the signer feel about life saving technologies and when they should be
applied? Statements like, "I do not want to be a vegetable" are not helpful
because nobody desires such an outcome. Modern medicine offers treatments that
prolong life or avoid death in many circumstances other than being in a
persistent vegetative state. But the
decision when it is appropriate to change the goals of care from cure to
comfort is a question that everyone should answer individually and share with
factors should be used to make that change? "Unable to interact with family and
friends" is a broad standard, but one that encompasses someone who is unable to
recognize others. If this is the case, do you not offer antibiotics in the
event of pneumonia? What about a feeding tube? Should CPR be declined?
intrusive treatment is known as allowing a natural death. It should be clear that
the patient will receive substantial treatment, but the focus will be comfort
and pain management, rather than prolonging death.
the other hand, some people firmly believe that every breath is precious and
every treatment should be provided to obtain as many breaths as possible. In
this case, the surrogate should know this and make decisions accordingly.
has been selected as the surrogate and who has not? Have all close family
members been told so that there are no surprises during a time of crisis?
many surrogates have been appointed to serve at one time? If there is more than one surrogate at a time
there will have to be a vote to make any decision, delaying care and increasing
frustration. If someone does not trust me to make the decision by myself, in
consultation with others, then
do not want to be selected at all. For
those of us willing to take on the task of being a health care agent, being
drawn into disputes in times of crisis should not be part of the deal.
and effective communication.
and Curran both concerned disputes over the desire of the patient. Clearly
setting forth the basic desires of care avoid having to resolve consent issues
in court. In addition to a clear description within the Directive regarding care,
it is helpful to have a short letter addressed "To Whom It May Concern" briefly
describing the patient's life and care desires: when life should not be
prolonged, when care should be withheld and when to forego extraordinary or
highly risky procedures, for example.
with relatives and close friends is also critical. The Advance Health Care
Directive should be widely distributed, even to those who care but are not
whether the patient wants to donate body parts for science, and make sure it is
clear what the patient wants to do with organs, tissue and other material. Is
there anyone who is to be excluded from knowing about the patient's condition or
from medical decision- making?
Anyone who agrees to be a health
care surrogate or agent is doing a great service. To do a good job, you must have
the authority and other interested parties must be aware of that. Insist upon it.
-Article and image contributed by
Jeff Loebl (Rotary Club of Ojai). It was originally published in the July 2013
edition of Citations, a publication of the Ventura County Barr Association.
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