Working in psychiatric services, I have learned one very important thing with regard to one’s healthcare… Appoint a healthcare representative or healthcare power of attorney. And don’t wait until you’re “old” (whatever your definition of that might be) to do it! Even before I started as director for an inpatient psych unit, I recognized the value of having someone appointed to make healthcare decisions for you, should you become incapacitated to do so. I had healthcare power of attorney paperwork drawn up for an anesthesiologist friend of mine, whom I have known for many years and may be the brightest physician – or individual, for that matter – that I know, filed it with the Court and made sure everyone in my immediate circle of care had a copy. Myself, parents, primary care provider, and of course the guy who would be serving as my HCPOA.
Please understand that you don’t have to appoint a physician, or the smartest person you know, to be your healthcare decision maker. Just appoint someone who you know well and who knows you well, who you trust, and you may want to consider refraining from appointing someone who could likely become incapacitated right along with you (like a spouse, in the case you’re in an accident together). This doesn’t have to be a formal legal document, though that is my recommendation. In most states, there is a form available appointing someone your healthcare representative that serves the same function. These forms are supported by state code, which should be clearly identified on the document, and you can request them in hospitals and most hospital-affiliated facilities. In my experience, a great many primary care providers offices also have them, as do many long-term care facilities.
Remember that whether you are completing a healthcare representative form or filing a formal healthcare power of attorney, you must be of sound mind and capable of making this decision. Oftentimes, this is not a difficult thing to determine. If someone is “of sound mind,” in other words alert and oriented to self, time, place and situation, and gives indication that they have adequate insight and judgement, they can appoint. Hence, best to do this before you reach an age where cognitive deficits MAY start to occur. I’ve had a ringside seat for more occurrences than I care to recount where people were unable to make their own healthcare decisions and did not have anyone appointed to make them on their behalf. Hear me when I say you do not want this to happen to you or your loved ones.
For what’s considered traditional medical treatment, this may not present a tremendous problem, depending on who your state has determined has say in your care, and depending on the facility where treatment is being rendered. In some states, for example, healthcare decision-making doesn’t automatically defer to the spouse. Take the case of Terri Schiavo in the Florida Supreme Court, for example (lasting from 1990-2005). In some states, in fact, as many as four or five persons can have priority say in your healthcare decisions! Spouse, parents, adult children, and siblings; sometimes even religious leaders and close friends are given consideration. There is usually hierarchy, starting with the spouse, though many states also have a majority rule (children and siblings), or even require that there is a consensus among the priority decision makers. Think to yourself, would your spouse, parents, adult children and adult siblings be able to unite on a decision for you? There is also usually a hierarchy established in a policy set forth by the facility where treatment is being rendered. Again, typically starting with the spouse. Despite hospital policy, however, with enough push from the various parties who have no unanimous decision, physicians can have a very difficult time executing orders regarding life and death. Both of these factors contributed to the Schiavo case. Ethics committees and the legal system are then called to be involved.
I reiterate that the above is in play for what’s considered traditional medical treatment but remember I work in psych, which is a whole new animal. You see, there is no hierarchy of decision-makers for psychiatric care. It’s either the patient making the decisions, their appointed healthcare surrogate or guardian making decisions, or… It’s psychiatrists in combination with a judge making their decisions, or a court-appointed guardian who knows nothing about your loved one making their decisions. There is no default to a family hierarchy in psych like there is in medical, and this is where things get difficult and sometimes very ugly. Your loved one could be set on a path which may exclude you entirely in decision-making, and they could end up in a place you never wanted them to be.
I won’t go into the details of consent for, detention to, or commitment to psychiatric care. The discussion can be lengthy and quite legally involved. If you have questions, I recommend consulting your state department of health (much of which can be searched online), a licensed mental health provider in your state, or an attorney who specializes in healthcare in your state. But again, I’m going to use the potential outcomes of psychiatric care to emphasize that if you don’t have a healthcare surrogate, you need to get one. Medical care decisions can be messy enough to warrant it, though psychiatric care begs for it. You may never think you or your loved ones will need psychiatric care, though I ask you to consider conditions that are considered psychiatric: Dementia. Delirium. Substance abuse. Depression. Anxiety. Personality disorders. If you or a loved one come to the hospital and any of these conditions are identified as a primary or secondary problem, you will receive a psychiatric consult and be considered for psychiatric admission or transfer to another facility for psychiatric admission (following medical clearance). So in that case, who do you want making your decisions?
Important to note, so as not to terrify anyone… A healthcare representative or healthcare power of attorney are activated ONLY under circumstances where you are unable to make your own decisions. As long as you are deemed capable of making your own healthcare decisions, you are afforded that right and that freedom regardless of the presence of a surrogate. [The only exception is guardianship, as a guardian has total decision-making power in all circumstances, which is why guardianship is generally only granted over minors and those adults or elders who have been determined chronically mentally incapacitated.]
GET YOUR HEALTHCARE REPRESENTATIVE IN PLACE NOW!