Question
3: When and how should your
proxies
be
empowered to make medical decisions?
Proxies were not needed thru most of the history of the human race
because
physical death usually followed soon after mental death.
And
most people were conscious and competent until their deaths.
But
the advance of medical science and life-support technology
has
stretched out the dying process so that many of us will be
alive in body for some time
after we are no longer alive
in mind.
This is the basic reason for writing Advanced Directives.
And
in your 'living will' you should be clear about
the
most appropriate time
for your proxies to take over your decisions.
In
some cases it will be obvious—for instance when you are unconscious.
But
there might be many in-between conditions
when
it is not clear who would be the best decision-makers.
Your
Answer to this Question will clarify just when your proxies decide.
Without a clear indication of who has the decision-making power,
hospital
politics might become involved in your medical care.
For
example, if the doctor knows that the patient would decide one way
and
the relatives (or some sub-set of relatives) would decide another way,
the
doctor might consult the deciders who will 'follow medical advice'.
You might specify that your proxies will activate themselves.
Your
proxies might call upon as much professional advice
as
they can get from the doctors and psychological professionals
in
deciding when to take over your medical decisions.
If
you have a Medical Care Decisions Committee,
they
can all interact with you to see how well you can handle decisions.
And
when they think it best to activate themselves as your MCDC,
they
can vote to take this responsibility upon themselves.
If
the condition that prevents you from making your own choices
is
likely to be temporary, your proxies can specify
that
they will make your decisions only temporarily.
And
when you have regained your decision-making abilities,
they
will officially notify the doctor in charge of your care
that
they are returning your decision-making power to you.
There might also be transitional periods
in
which you give your proxies the official power to decide for you,
but
you expect them to consult you as much as possible.
If
they cannot consult with you directly, in person,
they
will do their best to follow your Advance Directive.
QUESTION
3:
EMPOWERING YOUR
PROXIES by
JAMES
PARK
63
Establishing a formal process to transfer
decision-making power
would
probably be better than the present informal process,
which
is controlled by the doctors.
Normally
the doctor in charge of your case will informally decide
that
you are no longer the primary decision-maker;
and
the doctor will turn to whatever relative
seems
to be acting as 'next of kin' for any further medical decisions.
But such transfers of authority should be better organized.
A
formal means with appropriate documentation should reflect
when your proxies begin to
make all medical decisions for you.
Under many 'living will' laws (at least in their early versions),
an
Advance Directive does not come into force until the principal
has
been officially declared to be in a 'terminal condition'.
If
your 'living will' is operating under such a law,
your
proxies might never
officially get any authority to decide for you
because
the doctor might never
officially declare you 'terminal'.
If your 'living will' only becomes effective when you are 'terminal',
the
best way to empower your proxies might be
to
give them durable power of
attorney for health care.
Then
you can decide just when
to empower your proxies.
Under either form of law, you can empower your proxies to take over
whenever
you become unable to make your own decisions.
And
you could leave it to your proxies themselves
—advised
by the doctors involved in your care—
to
determine just when
to take on this authority.
In
this part of your Advance Directive you grant the explicit power
to
your proxies to decide exactly when and how to activate themselves.
Most doctors are not lawyers.
They
should not have to consult the hospital attorney
or
read the state law in order to determine who makes decisions.
Under
common law, you can
decide exactly when
your
proxies become your decision-makers.
If
you make a clear statement about this in your Advance Directive,
you
will not have to worry about the state law
—in
its present or any future form.
And
your doctors will be able to proceed with your care,
confident
that they are following the informed consent
of
the person(s) you have duly authorized to decide for you.
64
YOUR LAST YEAR: CREATING YOUR ADVANCE DIRECTIVE FOR MEDICAL CARE
The selection above is the beginning of Question 3 from the book:
Your
Last
Year: Creating Your Own Advance Directive for Medical Care.
If you click
this title, you will see
the complete table of contents.
The table of contents lists several special issues
within this Question about empowering proxies.
If you
would like to see one person's Answer to this Question,
go to James
Park's Advance Directive for Medical Care.
Scroll down to Answer 3.
Go to
the beginning of this website
James
Leonard Park—Free
Library