Of course, every family is different. One may have an older son who is trustworthy in the handling of finances, when at the same time a younger daughter is the one gifted in making medical decisions. This is where choosing a health care surrogate comes in.
In undertaking this procedure, make sure you understand your state’s laws. In many states, designation of a health care surrogate needs to be made through a written document and be signed in the presence of two witnesses, one of whom is neither a spouse nor blood relative. The person assigned as the surrogate cannot be a witness at all.
Always keep the original document in your personal files where it is accessible to others if needed. Have your physician place a copy in your medical records and, if hospitalized, bring a copy with you each and every time you are admitted. Your assigned surrogate also needs to maintain a copy in his or her file. In today’s electronic world, I advise all caregivers to have these crucial documents downloaded to his or her smart phone. (We seem to worry more these days, about leaving the house without our phones than without our own wallets.) You might also consider leaving a copy with your spiritual advisor. Another precaution is to name an alternative surrogate for back-up in case the primary surrogate is unavailable or unable to serve.
If you have an existing living will or advance care plan and you decide to make a change, destroy all former copies. In the event you have no plan put together and you are found lacking mental competence, it will be up to your doctor to appoint a surrogate. There is a set standard by which that person is selected. The first on the list is your spouse. Next in line would be one of your adult children, third a parent, then an adult grandchild, or, possibly, even a close friend.
You might wonder how the doctor decides when a patient is unable to make his or her own medical decisions. There are two methods observed by a physician, psychologist or advance nurse practitioner in making this determination; one has been the ascertaining of a person’s ability to appreciate the nature and implications of a health care decision and the person’s ability or inability to communicate personal choice in an unambiguous manner.
For example: I had to decide whether or not to prolong my father’s suffering and have a feeding tube inserted into his stomach. I decided, based on what I knew his wishes would be, that he had suffered long enough.
Personally, I believe the best thing to do is to assign a Medical Power of Attorney, and specify in writing what health care decisions can or cannot be made.
There is a lot of anguish and potential guilt for the persons designated as to whether they made the right choices. This is why it is so important for you, the potential patient, to sit down with the person you have chosen (and other family members) and clarify exactly what your wishes are.
Make sure that your prolonging or life-ending desires will be correctly carried out; make a living will and choose a health care surrogate before it is too late to do so.