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By the Meriter Hospital Ethics Committee
The following questions are answered in this article:
- What is a Healthcare Agent?
- Why Does Anyone Need a Healthcare Agent?
- How Does Someone Designate a Healthcare Agent?
- Am I Eligible to be a Healthcare Agent?
- What Do I Need to Know to be a Healthcare Agent?
- When Must I Assume My Responsibilities?
- What Are My Responsibilities?
- What If There is Disagreement about What to Do or I Don't Know What to Do?
- Questions for the Healthcare Agent to Ask the Patient
What is a Healthcare Agent?
A Healthcare Agent is someone who has been asked to make healthcare decisions for another person.
Why Does Anyone Need a Healthcare Agent?
Adults can generally make their own decisions about their healthcare. Sometimes, however, they lose the ability to understand information, make decisions or to make their wishes known. This is called "decisional capacity." When someone loses "decisional capacity" he or she needs someone else to make these decisions.
How Does Someone Designate a Healthcare Agent?
By completing a form called the Power of Attorney for Healthcare, a person can name someone they would like to make decisions for them, should the need arise.
Am I Eligible to be a Healthcare Agent?
A Healthcare Agent is usually a trusted relative or friend. You must be at least 18 years old. If you are the patient's healthcare provider (e.g. physician, nurse), you may not serve as a Healthcare Agent unless you also are part of the patient's family.
You should feel confident that the person naming you is "of sound mind" at the time the Power of Attorney for Healthcare document is signed and witnessed.
What Do I Need to Know to be a Healthcare Agent?
In order to make decisions for another person, as they would for themselves, you need to know how they feel about medical matters. For example, how do they feel about being on life support, about being in a coma or being fed through a tube? At the end of this article you will find a list of questions you can use to help you learn about the person's values and wishes. This is the most important part of your responsibility.
When Must I Assume My Responsibilities?
You need to learn about the person's wishes right away. You do not actually ever make decisions for someone else until or unless the person loses the ability to do that for him/herself. The medical staff will determine when the person no longer has "decisional capacity," and then ask you to start making decisions.
What Are My Responsibilities?
Your main responsibility is to know and understand the person's beliefs and concerns about medical treatments. You must be willing to make decisions that are consistent with the patient's wishes, and communicate those decisions to the healthcare team. Your responsibility is to do what the person would want, not what you would want.
You will need to talk regularly with the patient's doctors. You need to stay informed of the patient's condition, the treatment plan and chances for recovery. It is up to you to be certain that treatment goals match the patient's wishes. If they do not, you must tell the doctor this.
What If There is Disagreement about What to Do or I Don't Know What to Do?
Some physicians may have a hard time following a course that you feel the patient would want. The physician may, for example, want to use treatments that will keep the patient alive, even if it means surviving at a much lower level of functioning. If you know this is not what the patient would want, you must tell the physician this. Also, situations may arise where the person did not explain exactly what they might want.
Since it may be very difficult to make decisions or come to agreement under these circumstances, you may find it helpful to speak with someone from the Meriter Hospital Ethics Committee, a hospital social worker, a chaplain, a hospital administrator or an attorney. You can ask the patient's nurse to help you contact one of these people or call a Patient Representative at (608) 417-6462.
Questions for the Healthcare Agent to Ask the Patient?
- How would you describe your current health status? Your quality of life?
- How important is independence or self-sufficiency to you?
- What are your general attitudes about illness, dying and death?
- How would your attitude by affected if your physical or mental abilities were decreased?
- How do you feel about using these treatments? Think about how long you might want them tried and under what conditions (for example: prognosis, mental status and odds of successful outcome).
- Ventilator (breathing machine)
- Artificial nutrition (through a tube in the nose or the abdomen plus tubes inserted into veins)
- Kidney dialysis
- Drugs to maintain heart rate and blood pressure
- Attempting resuscitation: chest compressions, artificial respiration, defibrillation (shocking)
- What part does religion play in your life?
- How do your religious beliefs affect your attitude toward a serious or terminal illness?
- What do you think will be important to you as you are dying (for example: pain control, having family members present)?
- Do you want to donate any parts of your body after you die?
- Have you discussed your wishes about end of life care with your doctor? Do you trust your doctor to carry out your wishes?
- Who do you think should be involved in making decisions about your medical care?
- What else can you tell me that will help me make decisions about your healthcare as you would?
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9/1/2005
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