Deciding on health care can be stressful, especially when facing complex medical situations. This guide offers patients and their families a framework for navigating these decisions, focusing on communication, understanding, and shared decision-making. It’s based on established guidelines for healthcare decision-making, adapted to promote a more collaborative approach.
Understanding Your Rights and Options
Informed Consent: The Cornerstone of Shared Decisions
Patients have the right to be fully informed about their medical condition, proposed treatments, and available alternatives. This is known as “informed consent.” Doctors should explain the benefits and risks of each option, allowing patients to make informed decisions about their care.
Alt text: A doctor explains treatment options to a patient sitting at a desk in an office setting.
Decision-Making Capacity: Who Decides?
Adult patients with “decision-making capacity” have the right to make their own health care decisions. This means they understand the nature and consequences of their choices. If a patient’s capacity is unclear, a doctor will assess their ability to make informed decisions.
Advance Directives: Planning for the Future
Health Care Proxy: Appointing Your Advocate
A health care proxy is a legal document that allows you to appoint someone you trust—your “health care agent”—to make medical decisions on your behalf if you become unable to do so.
Alt text: The health care proxy form, enabling patients to appoint a trusted healthcare agent.
Discuss your wishes with your agent, including preferences regarding life-sustaining treatments, artificial nutrition, and hydration.
Living Will: Expressing Your Treatment Preferences
A living will is a written statement outlining your specific instructions and choices regarding medical treatments. It can be included in a health care proxy or as a separate document.
Navigating Healthcare Decisions in Hospitals and Nursing Homes
Expressing Your Wishes: Verbal and Written Decisions
Patients can express their decisions verbally or in writing. Decisions about withholding or withdrawing life-sustaining treatment must be witnessed by two adults, one of whom is a health care practitioner.
The Surrogate List: When You Can’t Decide
If a patient lacks decision-making capacity and doesn’t have a health care proxy, a “surrogate” makes decisions on their behalf. The surrogate list prioritizes decision-makers:
- Spouse or domestic partner
- Adult son or daughter
- Parent
- Adult brother or sister
- Close friend
Alt text: Family members gather around a patient’s bedside in a hospital room.
A “close friend” is someone who has regular contact with the patient, knows their activities, health, and beliefs, and provides a signed statement to that effect.
Decisions About Life-Sustaining Treatment
Understanding Life-Sustaining Treatment and CPR
“Life-sustaining treatment” is medical care necessary to prevent imminent death. CPR (cardiopulmonary resuscitation) is a set of procedures to restart a patient’s heart and breathing.
Withholding or Withdrawing Treatment: Your Right to Choose
Patients have the right to refuse medical treatment, including life-sustaining measures. This can involve deciding not to start (withhold) or to stop (withdraw) treatment.
Alt text: Doctor discussing DNR (Do Not Resuscitate) order with patient and family, ensuring understanding and consent.
DNR Orders: Directing No CPR
A DNR (Do Not Resuscitate) order instructs health care professionals not to perform CPR if a patient’s heart stops or they stop breathing. This allows natural death to occur. A DNR order does not affect other treatments.
Resolving Disputes and Ethical Considerations
Ethics Review Committees: Seeking Guidance
Hospitals and nursing homes have ethics review committees to provide advice and assistance in resolving disputes about health care decisions.
Facility Policies and Religious Beliefs
If a health care facility’s policies conflict with a patient’s wishes, the facility must inform the patient and cooperate in transferring them to another facility that honors their decision.
DNR Orders Outside of Facilities
Nonhospital DNR Orders: Honoring Wishes at Home
Patients can obtain a nonhospital DNR order to ensure their wishes are respected outside of a hospital or nursing home. Emergency Medical Services (EMS), home care agencies, and hospices must honor these orders.
Calling an Ambulance with a DNR Order
If a patient with a nonhospital DNR order needs medical assistance, emergency personnel will not perform CPR if the order is presented. They may still provide other necessary care, including pain relief.
Conclusion: Empowering Patients and Families
Navigating health care decisions requires open communication, a clear understanding of your rights, and a proactive approach to planning. By appointing a health care agent, expressing your treatment preferences in writing, and engaging in shared decision-making with your doctors, you can ensure that your values and wishes are respected throughout your medical journey. Remember to continuously discuss and update your advance directives as your health and circumstances evolve. This collaborative approach empowers both patients and their families to navigate complex medical situations with greater confidence and peace of mind.
