Thread: As a medical ethicist, let me remind everyone that there is never a wrong time to make sure your family and/or friends know your wishes should you become unable to make medical decisions. And, it is even more important than normal now, with a pandemic 1/
It is often uncomfortable to grapple with questions of what sorts of medical treatments a person may or may not want in different situations, because we don’t like thinking about our own mortality and because it is difficult to predict what sorts of issues could arise 2/
For example, I personally am not interested in a life of intractable pain. But, I would be willing to undergo non-stop pain for a period of time, if it will eventually be resolved and I can live painfree afterward. How long a period of time? I don’t know. 3/
So, if my husband knows I’m willing to accept short-term non-stop pain but not permanent pain, he’d be better positioned to make a treatment decision for me if I can’t. Which is good! 4/
But because this is only a general guidance, he would have to try to figure out what I’d want if the drs said with continued treatment there was 50% chance my pain would eventually resolve but an equal likelihood it wouldn’t 5/
Trying to make decisions for other people is tough; you agonize over if you really are making the decision they’d want you to make. It is even tougher if you really don’t have any sense of what they’d want! 6/
But throwing out endless scenarios without context isn’t incredibly helpful in understanding what someone would want done in a future scenario 7/
There are resources like this fivewishes.org/shop/order/pro… that can help people discuss with others what they’d like done, if they are unable to make their decisions 8/
It is important to remember that state law specifies who may make medical decisions on behalf of a person unable to do so. In some states, the default is a spouse; in other states it can be a spouse, a common-law spouse, or a domestic partner 9/
If you want a specific person to make decisions for you, you shouldn’t just trust that will happen on its own! But if you have appointed someone your healthcare proxy, they get to decide for you, even if, by law, the decider would be someone else 10/
So, if you want a specific person to make medical decisions for you if you can’t, identify that person. Ask them if they are willing to do this. If they say yes, talk to them about any wishes they should know. Write down that you want them to be your surrogate decisionmaker 11/
Make sure you give them a copy of that signed & dated document. Give a copy to your drs and ask it be added to your medical record. Consider adding them to your phone’s address book under the title “in case of emergency.” 12/
Make sure your other friends and family know that you want this person to make medical decisions for you if you can’t. Make sure you have an ongoing conversation with your chosen surrogate re your desires, especially as your medical or life situation changes 13/
If you change your surrogate, you need to write a new statement, and sign and date it, in order for the previous document to become invalid. You should inform friends & family of this change & get the updated document into your medical record 14/
Above all, you need to make sure any preferences you have are communicated! If no one knows how you feel, decisions made on your behalf may, or may not, reflect your desires. 15/
Occasionally it may be your wishes can’t be the guiding factor in medical decision-making (for example, if there are insufficient medical supplies to meet all the need & triaging must occur) 16/
But, normally, your decisions, as written down in a living will or as expressed by a designated surrogate decisionmaker, are the final word. So please, express your preferences, both for your own benefit & to help those you’ve asked to decide for you. End
