Healthcare Proxy and Advance Directives

Healthcare Proxy means “appointing someone to make healthcare decisions for you in the event that you are unable to so yourself”. This has to be in writing. Appointing a healthcare proxy is a big problem for many of us and our patients. This could be due to any of several reasons. The primary one being that “nothing will happen to me”, another is that we do not like to discuss death. It can also be that we have many loved ones (especially children) that we don’t want to offend any by just appointing only one, and in some cases, we just assume that our spouse or parent is automatically our healthcare proxy. In the rare cases where one appoints a proxy, there is no documentation giving the appointed proxy legitimacy because it is not written on paper. Unfortunately, not taking the time to make this important decision and taking the necessary action brings unimaginable suffering to the patient, rips the family apart and places the healthcare practitioners in very awkward position. Many of us hope to live to ripe old age and die peacefully in our sleep, or have a massive heart attack and die instantly, while others don’t even want to think about death at all. The inevitable truth is that we all will die one way or another someday.
Advance directive on the other hand is making one’s wishes known about end-of-life care. In the rare cases that people appoint a proxy, they fail to make their wishes known and this leaves the proxy with a lot of burden as to what decisions to make. This also has ripped families apart. Make your wishes known. Do you want life support or not? Under what conditions?
I work in the medical intensive care unit in a hospital where people die in life support or under circumstances that require decisions of end-of-life issues. It is sad to witness the fights, struggle for power and even accusations that go on among family members at the bedside of a dying patient because there is no appointed proxy or advance directives. There have been cases where the spouse or one child doesn’t want to let go, but another wants to end the patient’s suffering. People accuse one another of not caring about the dying one or of wanting to torture the patient. In some cases, it becomes a power contest. Sometimes others just want to be vindictive for whatever reason. But the issue remains, that a decision has to be made as to the course of care. The question becomes, “who is making this decision for you?” Is it in your best interest?
One particular case involved a man who was separated (not divorced) from his wife for seven years. He lived with his fiancée of seven years in one state and his estranged wife lives in another. Shortly after his separation, he was diagnosed with cancer, his fiancée was with him during his treatments, remissions and relapses. In his final days, he became unconscious and was put on life support. He did not appoint his fiancée as proxy and because she was not his wife, she could not make decisions for him. The hospital has to wait for the wife who hasn’t seen this man in the seven years of his illness to make decisions for him. She wanted everything done. She never showed up at the hospital. This man had to be resuscitated each time his heart stopped (which was several) while the fiancée cried that “he never wanted any of this, please let him go”. Of course the wife’s wishes have to be carried out.
It is important that patients make these decisions when they are in good health and of sound mind. In most states, it doesn't have to involve a lawyer but it has to be signed and notorized. Find out what is acceptable in your state. Physicians are in a better position to educate their patients on this important decision. I understand how difficult it will be for a patient to go for his annual physical and his doctor is talking to him about making end-of-life decisions. However, it is a decision that has to be made and patients cannot make it unless they are aware of it. As individuals too, we have to make these decisions because physicians die too. Let us educate ourselves, our family members and most importantly our patients on the need for appointing a healthcare proxy and having advance directives in writing. It saves everyone the pain and agony of uncomfortable decisions.