But despite my checks and balances, I had almost allowed the wrong person to make crucial decisions for this vulnerable patient. And I had nearly excluded a wife from her rightful place on her husband’s team. Missing this crucial piece of information would have caused far more suffering and damage than any miscalibration of a ventilator.
In thinking about end-of-life choices, whether for yourself or for an elderly loved one, it is vital to understand what goes on and appreciate the difficulties that can arise. Some difficulties to think about are medical, and still others are entirely personal. Doctors are used to dealing with medical problems, but have a harder time thinking about the personal ones.
For the thoughts and an appreciation for these difficulties, you might want to read a recent article in The New York Times titled “Who Can Speak for the Patient?”
Doctors have an incredibly difficult role to play at a very important juncture in the lives of a patient and their family. This “role” is above and beyond their job of ensuring for medical care. The role of the doctor is to relay the medical information and difficult prognosis to decisions makers, but that is not always clear to the doctors or the hospital. In the original article, a very common family situation became the backdrop for a decision about whether to continue life-sustaining care, and the wrong person was almost relied upon for innocent and understandable reasons.
The takeaway from this instructive article should be an awareness of how vital it is to maintain readily available records, so it is clear who is responsible when a patient cannot make their own choices and what kind of choices those might be. In this case, once the wife was properly identified, then she was able to make the right decisions. However, precious time is lost and family strife can build when it is not clear who has authority. These are things we all have to think about, and it is necessary to think them through before it is too late.
Reference: The New York Times (June 19, 2014) “Who Can Speak for the Patient?”
