You should provide your living will – either your living will or a doctor`s power of attorney – to your medical provider, family and close friends, and your own lawyer, if applicable. States also describe groups whose capacity to serve as decision-makers is limited to cases where they are related to the patient disabled by blood, marriage or adoption. The group most often barred from serving as alternative decision-makers are health care providers, with 35 states restricting or prohibiting their service in this role. Thirty-six states state that the other decision-maker “should be willing to act,” although none specify how “readiness” should be determined. Some statutes list but do not define attributes such as “reasonably available,” while others contain several paragraphs describing requirements such as frequency of contact with the patient before and during the incapacitated illness and availability for a face-to-face meeting with health care providers. Similarly, the term “special care and concern” is sometimes cited as a requirement for any other decision-maker and sometimes applies only to a friend in that position. A living will is a written legal document that lists the medical treatments that keep you alive and that you don`t want to use, as well as your preferences for other medical decisions, such as pain management or organ donation. However, any wishes you communicate to your doctor in writing are legally binding, unless your doctor has a legal or ethical reason for not following through on your wishes. A study published in the New England Journal of Medicine shows that 40% of adult hospitalized patients and patients hospitalized in hospices are unable to work. Among patients in intensive care units, more than 90% cannot make their own medical decisions. However, according to the Journal of the American Bar Association Commission on Law and Aging, two-thirds of all adults do not have a living will or medical power of attorney. For patients who are unable to work and do not have a living will to indicate their preferences for medical decisions, there are two options: a court-appointed guardian or a substitute decision-maker. Patients often live in one state and receive care in another, and about one-fifth of U.S.
physicians have medical licenses in multiple states.9 With different local laws, health systems that cross state borders may struggle to formulate consistent institutional guidelines for medical decision-making for patients who lack decision-making capacity. especially for end-of-life care. Clear consensus guidelines that focus on life-sustaining interventions also rely in part on assumptions of nationally consistent decision-making parameters that may not be supported by legislation.10 More broadly, examining the variability of laws can reveal how patients and medical decisions may be treated differently in different jurisdictions. When choosing your agent in your medical power of attorney, appoint someone with the necessary qualities to see your wishes fulfilled. It is imperative to appoint someone who: We also assessed the hierarchical treatment of potential alternative decision-makers in each state. Laws defining a surrogacy scale have been identified. If such a scale existed, we noted the particular circumstances in which it was used and assessed the priority of the persons (or classes of persons) it contained. Precise terminology that describes who has decision-making authority over an incapacitated patient is essential to clarify legal differences. We use “alternative decision-maker” to refer to anyone involved in decision-making for such a patient, whether appointed by the court, the patient (in a living will) or a standard substitute law. A person who assumes decision-making authority without being appointed by the court system or prospectively authorized by the patient at a time when he or she had decision-making capacity is a “standard surrogate.” The legislation that regulates standard surrogate consent in many states establishes a hierarchical list of priorities of people to serve as decision-makers, whom we call “surrogacy leaders.” Typically, these are things doctors only have to decide in an emergency, usually when you`re unconscious or incapable. These decisions may include: There is a broad ethical consensus that other people can make life-and-death decisions on behalf of patients who lack the capacity to make decisions.
In recent decades, many states have passed laws to delineate the decision-making power of patients without living wills.8 However, the 50 U.S. states and the District of Columbia differ in their procedures for appointing and challenging surrogates, the characteristics they require of surrogates, their priority for potential decision-makers, and dispute resolution. These differences have important implications for clinicians, patients and public health. We created a tabular nomenclature describing the types of alternative decision-makers in each state (for the purposes of our discussion, the District of Columbia is considered a state) and looked for laws that provide for the designation of a standard surrogate if the patient did not have a permanent health lawyer or court-appointed guardian. We assessed all laws against criteria of relevance of another decision-maker and characterized the characteristics that were identified as necessary for an individual as such. If you don`t have an advance directive and become unable to work, someone else will make your medical decisions for you, and they may not be the person you want to make your decisions. It may not even be someone you know. Many patients cannot make their own medical decisions because they have lost the so-called decision-making ability. The estimated prevalence of decision-making disability approaches 40% in adult inpatients and hospice1,2 and exceeds 90% in adults in some intensive care units.3,4 Patients who are unable to make decisions about their own care may be guided by a living will. a legal document that sets out treatment preferences or establishes a standing power of attorney for health care. or both.
