For a seriously ill patient without a health care proxy agent—an individual legally permitted to make decisions for a patient who is incapacitated—their condition can be not only painful for family members, but logistically untenable. Frequently in those cases, when end-of-life decisions are on the table, loved ones must currently look to the courts for clarity. Though a guardian can be appointed in the absence of a health care proxy agent, a guardian’s decision-making capacity is often far more limited than an agent’s would be. So loved ones already in a difficult position must appear in front of a judge to make those choices for the patient.

This should change, argues Richard Leiter, MD, MA, a palliative care physician at Brigham and Women’s Hospital. He points out that states including New York have passed legislation aimed at fixing this system, which often goes too far in protecting patients’ rights, even when family members say their loved one’s wishes for care are crystal clear. Such legislation allows a list of “surrogate” decision-makers to represent their loved one’s interests without court battles. A similar bill is currently under consideration in Massachusetts, he says, which could shield families here from unnecessary legal proceedings.

Either way, notes Dr. Leiter, there is a simple way to avoid the complication completely. “Take the time to complete a health care proxy form,” he advises. “A few minutes now may allow your loved ones to protect you when you’re most vulnerable.”

Read more at WBUR’s Cognoscenti.

Topics: Patient Experience, Academic Medical Centers

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