Happy patient, unhappy family…

Many people are aware of the importance of  advance medical directives and having a designated medical proxy/health care power of attorney authorized to make decisions when you, the patient, cannot.  The one mistake I see time and again is selecting a close family member for this critical role.  Many times I have seen patients express their wishes very clearly, then appoint someone to see that they are carried out who cannot handle the pressure put on them by other family members.

I was recently in the ICU to see a patient who had appointed me as their medical proxy several years ago.  We had a long discussion to document their wishes and expectations around their medical care, with an annual recertification in the event they had any second thoughts.  They are now at the stage when they can no longer meaningfully participate in their care decisions, effectively non compos mentis.

Seeing his family for the first time, I understand why he did not want any of them as his medical proxy.  One child is of the “do anything humanly possible” school, and is waiting for Dr. House to walk in with a miracle cure.  Another believes the parent didn’t think everything through, and a third thinks that homeopathy is the miracle they need.  The fourth offspring supports the wishes of the parent, but is obviously being bullied by the other three.

Had any one of them been designated medical proxy, it’s obvious that either the wishes of the patient would be ignored, or you’d end up with a divided and fractured family dynamic.  My discussion with the family was brief and succinct.  I wasn’t interested in their opinions, and would only be directing care along the parameters spelled out by their parent.  They don’t have to like me, and once the healthcare journey was over they would never see or hear from me again.  But I made it clear that any attempt to interfere with care decisions would have them physically removed and barred from the hospital, with associated criminal charges.  The lawyer for the estate also made it clear that there would be consequences for any attempts to circumvent the medical directives.

Family unity often goes out the window when care decisions need to be made.  I have seen relatives come to blows in the waiting room (and even at the bedside) over decisions.  The wise patient uses an external agent, one who is out of the loop of family dynamics and will focus solely on their wishes.

When I left their bedside, I assured the patient that I was following their directives to the letter.  It’s impossible to say if they recognized me, or what I was saying, but I did receive a smile, so maybe they know and took comfort in that message.  When cures are no longer an option, dignity is the last thing that must be assured for the patient.