If a proxy is named, make your care choices known

[okarol]

If a proxy is named, make your care choices known
Tuesday, May 20, 2008

DECISIONS ABOUT CARE when we cannot make the judgment ourselves and end-of-life care are subjects considered far too infrequently. Yet, unlike even the most common disease, these are issues of importance to every individual.

One of the biggest difficulties many people have is anticipating the circumstances likely to exist when these issues are likely to occur. This is understandable, since an individual usually does not know what disease -- or perhaps, group of diseases -- will be responsible for his death.

Furthermore, it is impossible to predict the acuity of the situation in which a decision must be made. Will he have days or hours to make a decision, or might a decision need to be made almost immediately? How important might a decision about a particular plan of care be? A decision about a procedure likely to result in minimal change in functional capacity would be treated differently than one about a major surgical procedure. In considering many issues, the individual might find it difficult to determine how serious the side effects of each treatment option might be.

Would an individual be willing to have a procedure -- for example, kidney dialysis -- for a limited period of time before deciding to forgo it under any circumstance? How much discomfort and dependence would an elder be willing to tolerate before deciding to discontinue a treatment? Wouldn't this be an especially difficult decision to make if a treatment's ability to lengthen life might be difficult to assess or an intervention would do so for only a very limited period of time?

There are social circumstances to be considered as well. If one's spouse had died, the person might have a different wish with respect to aggressive care than if the spouse were alive. Would the elder want to be certain the needs of other family members were considered as well? Would financial considerations play a role?

It's hard to consider all of these types of issues when we envision making a major health-care decision. Nonetheless, we should designate an individual to act as our health-care proxy, who will be entrusted to make a health-care decision if we lack capacity to do so. When a decision must be made, perhaps urgently, there should be no confusion as to who should be contacted by the doctor.

It is important for each of us to discuss with our health-care proxy and our physician what our general desires might be. We may not be able to anticipate all possible scenarios, but providing a broad outline and naming a health-care proxy will allow each of us to have some measure of control over important decisions when we cannot participate personally. It also will relieve the individual serving as the proxy from worrying that he or she might not be doing what the person wished.

Write to Dr. R. Knight Steel at Hackensack University Medical Center, 30 Prospect Ave., Hackensack, N.J. 07601.

http://www.nj.com/living/ledger/index.ssf?/base/living-0/1211258225145710.xml&coll=1