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PATTI'S BLOG

Friday, August 17, 2018

What it means to be a healthcare surrogate

In my practice, I spend a lot of time educating clients about the need to have an Advance Directive for Healthcare in place so that someone can make healthcare decisions for them if they are unable to make those decisions or to communicate them.  But what does the healthcare agent or surrogate do?

When nominated to become a surrogate healthcare decision maker for someone, you may be asked to make decisions about what healthcare procedures and care will be appropriate for someone other than yourself. You will only be asked to make healthcare decisions if the person is not able to make or communicate those decisions.  What that means is that you may have to decide what the person would want without ever having discussed the issue with them.

In general, as a healthcare surrogate you will have the right to:

  • Make choices about all medical care for the person, to include surgery, medical tests, medical tests or pain management.

  • Make choices about where the person will receive treatment

  • Take legal action in order to have the person’s wishes honored

  • Apply for insurance, including Medicare and Medicaid for the person

In order to make these decisions, learn as much about the person’s health care as possible.  For instance, introduce yourself to the person’s physicians, dentists, caregivers, etc. to learn about any diagnosis of illness or disease, and the treatment the person is receiving for that illness or disease. 

Get copies of the medical records for the past few years to learn whether the person had surgery, what medications the person is currently taking, or has taken in the past, and what disease or illness the medication is meant to treat. Have a discussion with the physician and other healthcare providers to determine whether the current treatment and medications are necessary. Find out whether there are any side effects of the prescribed medications or treatment. Determine whether the disease normally requires a specialist, whether the current physician is such a specialist and, if not, whether to seek out a specialist.

If you know you have been nominated as a surrogate, and the person who nominated you is still able to discuss their wishes, have a conversation with them to determine what treatment they would want to authorize. 

While many of the decisions you may be asked to make as a surrogate do not involve end of life decisions, at some point you may be asked to determine whether to authorize treatment that cannot cure someone, but may prolong life. 

 In his book “on being mortal- Illness, Medicine, and What Matters in the End”, Dr. Atul Guwande explored the subject of end of life treatment and good death, and provided some ideas about ways to approach someone to discuss their desires for end of life care.

Dr. Guwande proposed 5 questions to ask to help determine what actions to take at the end of that person’s life:

  1. What is your understanding of where you are and your illness?

  2. What are your fears and worries for the future?

  3. What are your goals and priorities?

  4. What outcomes are unacceptable to you?  What are you willing to sacrifice and not willing to sacrifice?

  5. What does a good day look like for you?

According to Dr. Guwande, the answer to these questions may help determine what kind of end-of-life care to give.  He acknowledges that the answer to those questions may change with the age and disease progression of the person.  In his book, he tells the story that when he asked his father what his father would consider to be a good quality of life, his father told him that he thought that a good day would be if he could eat ice cream and watch football on T.V.  His father was a social person, he would not want any aggressive treatment that would leave him a quadriplegic or might cause him to require a ventilator or a feeding tube. Dr. Guwande contrasts that with the young mother facing a terminal illness who might opt for more aggressive treatment in order to remain with her young children because a good day for her might be just being around those children. 

Although the conversations are very difficult, Dr. Guwande suggests that the more you know about what the person believes is a good quality of life, the better decisions you can make for her or him.


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