Download Your Surrogate… Can begin making decisions for you only when

Your Surrogate…
1. Can begin making decisions for you only when your doctor
determines that you are no longer able to make health care
decisions for yourself.
2. May make any and all health care decisions for you within the
boundaries of reasonableness, including treatments for physical
and mental conditions and decisions regarding life-sustaining
procedures…UNLESS you limit the power of your surrogate.
3. Subject to certain exceptions in the law, will have power to
authorize the withholding or withdrawal of life-prolonging
treatment and decisions about the artificial provision of nutrition
and hydration (feeding tubes).
4. Is protected from legal liability when acting in good faith.
5. Must make a decision based on your expressed wishes and values
or your “best interests”; this will take precedence over other
decisions, regardless of family relationships.
6. May have his or her decision challenged if your family, health care
provider or close friend believes the surrogate is acting in bad
faith or is not acting in accord with your wishes and
religious/moral beliefs.
SCN Meetings/Table 6/Continuity Group/8-05
What Health Care Providers Should
Expect of Surrogates
 Basic comprehension of the surrogate’s role
 Availability for discussion
 Prompt response to requests for decision making
 Willingness to discuss overall goals of care
 Willingness to collaborate in care planning
 Willingness to make use of available community resources
including ethics committees and ombudsmen when necessary.
SCN Meetings/Table 4/Continuity Group/8-05
What Surrogates Should Expect
From Health Care Providers
 Accessibility
 Communication about diagnosis, prognosis, available treatment
options and life expectancy
 Description of the benefits and burdens of each treatment
 Recommendations for treatment and discussion of the reasoning
underlying the recommendations
 Access to pertinent written education materials or journal articles
 Written communication of recommendations about treatment
and their justification, when requested
 Access to ethics committees
 Emotional support
SCN Meetings/Table 3/Continuity Group/8-05
A Framework for Assessing Capacity to Make
Medical Decisions
Can the person make and express personal preferences at all?
Can the person give reasons for the alternatives selected?
Are the supporting reasons rational in the sense that the person
begins with a plausible idea and reasons logically from that premise to
a result?
Can the person comprehend the personal implications, namely the
probable risks and benefits, of the various choices presented and
selected?
SCN Meetings/Table 1/Continuity Group/8-05
Hierarchy of Medical Decision-Making for
Incapacitated Patients
Advance Directives specified by the patient before (s)he became
incapacitated prevail, even over the contrary wishes of guardians and
other surrogate decision-makers.
The decisions of the guardian or of a surrogate designated in an
Advance Directive prevail over all others except in the presence of a
written Advance Directive.
Decisions of surrogates, including guardians, should be guided by:
 Substituted judgment (if the incapacitated person’s wishes were
known but not formalized in an Advance Directive)
 Best interest of the patient, based on clinical evidence,
prognosis, life expectancy, risk and benefit of proposed
treatments, comfort and dignity
Family members and friends take precedence next, usually in the
following order:
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

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
Spouse
Adult children
Siblings
Other family members
Friend
Health care providers follow, in the absence of other decisionmakers (not optimal)
SCN Meetings/Table 2/Continuity Group/8-05
Definition of “Life-Support Treatment”
Life-support treatment means any medical procedure, device or
medication to keep me alive.
Life-support treatment includes:
 Medical devices put in me to help me breathe
 Food and water supplied artificially by medical device (tube
feeding)
 Cardiopulmonary resuscitation (CPR)
 Major surgery
 Blood transfusions
 Dialysis
 Antibiotics
SCN Meetings/Life Support/Continuity Group/8-05
My Wish for the Kind of Medical Treatment I
Want or Don’t Want
I believe that my life is precious and I deserve to be treated with dignity.
When the time comes that I am very sick and am not able to speak for
myself, I want the following wishes, and any other instructions I have
given to my Health Care Agent, to be respected and followed.
The instructions that I am including in this section are to let my
family, my doctors and other health care providers, my friends and all
others know the kind of medical treatment that I want or don’t want.
A. General Instructions
 I do not want to be in pain. I want my doctor to give me
enough medicine to relieve my pain; even if that means that I
will be drowsy or sleep more that I would otherwise.
 I do not want anything done or omitted by my doctors or nurses
with the intention of taking my life.
 I want to be offered food and fluids by mouth, and kept clean
and warm.
B. Meaning of “Life-Support Treatment”
Life-support treatment means any medical procedure, device or
medication to keep me alive. Life-support treatment includes: medical
devices put in me to help me breathe; food and water supplied
artificially by medical device (tube feeding); cardiopulmonary
resuscitation (CPR); major surgery; blood transfusions; dialysis; and
antibiotics.
If I wish to limit the meaning of life support treatment, I write this
limitation in the space below:
C. If I am close to death:
If my doctor and another health care professional both decide that I
am likely to die within a short period of time, and life-support
treatment would only postpone the moment of my death (choose one
of the following):
 I want to have life-support treatment.
 I do not want life-support treatment. If it has been started, I
want it stopped.
 I want to have life-support treatment if my doctor believes it
could help, but I want my doctor to stop giving me life-support
treatment if it is not helping my health condition or symptoms.
SCN Meetings/My Wish/Continuity Group/8-05