Who will speak for you?

My nursing clinical this past semester had me working in the Geriatrics ward at my hospital and I had to face and watch families make critical and heart wrenching decisions for their loved ones who hadn’t left any instructions as to their wishes. Standing on the outside watching, it was hard to see families being torn apart.  Each one thinking they knew what the patient would want.  Arguing that they had the patient’s best interest at heart.  Sometimes it wasn’t always so cut and dry.  Sometimes a lifetime companion is shut out from medical decisions because they weren’t legally wed, and instead a person who was not close with the patient was left to make crucial medical decisions.

In my own life, I watch my husband’s family deal with the aftermath of his grandmother’s stroke.  In my visits with her I saw the sadness in her eyes and I wondered what she was thinking in her inability to communicate with us.  I tried to remember her strength and passion and wondered what she would want or what she would say to us if she could speak.  It made me take a hard look at what choices I would want to make in the same position.

From the clinical side of things, I also had to face hard facts.  Orders for a DNR and DNI are often markers for decreased patient care.  Doctors and nurses don’t intentionally provide less care, but research has shown that patients with orders don’t receive optimal care as patient’s who don’t.  What ensues is that many patient’s opt not to place orders because they are afraid they won’t be cared for.  While education of both patients and healthcare workers are an important priority, there is another option – Health Care Proxy.

What is a health care proxy you might ask?  It’s not to be confused with an order for DNR – Do Not Resuscitate or DNI – Do Not Intubate.  Rather its a directive that indicates who you’d like to make health care decisions for you in case you can not.

It is important to consider and to think about your individual wishes as they relate to how you want to live the remainder of your life. Most people don’t have any idea how to begin to think about this or begin a discussion about this, but I urge everyone to begin this discussion. To help you navigate through what decisions you might need to consider there are tools that can guide you.

Isn’t the web a wonderful thing?  A blank healthcare proxy can be downloaded online by searching “Health Care Proxy” and your state of residence, ie. “New York“.  It is a fairly self explanatory form that does not require a lawyer.  It will require signatures from two witnesses.  In your health care proxy you can indicate who are your first and second choices for making health care decisions on your behalf if you cannot as well as the extent of healthcare decisions they can make on your behalf.  You can also state exceptions which include in case of divorce,  in case of death and even describe in length wishes according to potential medical situations that may arise.  There also is an area to make your organ donation wishes known.

The greatest comfort you can give to your family in times of crisis is a Health Care Proxy.  So set aside some time and make your wishes known.