              |
 |
September 2006 Back to Table of Contents Back to Archives Main Page Section: Being Well The Health Care Proxy By Toby Laping, Ph. D., C.S.W., Private Care Manager
Families are often deeply grieved by the protracted pain and subsequent deaths of loved ones. Consistent with health care advanced directives and with the knowledge that their loved one is dying, families ask for comfort measures but don’t realize all that might be involved. Terms need clarification and families often need to push to make sure their wishes are understood. Families may have more control than they exercise. A basic premise, I repeat, is that all of us must have advanced health care directives. And, those directives must be discussed with the person identified as the health care proxy, and with other family members or friends who may have strong feelings about our well being. Our physicians, attorneys and other important professionals in our lives should have a copy. People who act as health care proxies often are clear and decisive with health care professionals about not permitting use of a feeding tube, about the dying person’s not wanting to be on a ventilator, and other choices. But then, those people who probably love the patient dearly can find themselves in the terrible position of watching that patient die slowly and perhaps uncomfortably. They know that isn’t what the patient wants and it isn’t what they want for their loved one, but people often feel they have no other choice. That isn’t always accurate. When patients are terminally ill, there may be steps that the health care proxy should consider for which your loved one might be very grateful. First of all, the proxy must be very clear and outspoken about the fact that his loved one wants comfort care only, and the proxy’s obligation is to ensure this type of care is provided. Those proxies can, for example, ask that Hospice care be provided. They may need to monitor the situation to ensure that this request is honored. Perhaps those proxies should ask the physician to review each medication being administered. If the patient is being given medications to maintain a regular heartbeat or cholesterol level, a fair question for the physician is, “what will happen if those medications are withdrawn. Will there be pain? Will the patient be comfortable? Will the patient deteriorate slowly or will death be hastened?” These are not taboo subjects, but may remain unspoken. Proxies can ask about orders to push nourishment. If the patient doesn’t want to eat and that’s consistent with the prognosis, consider whether it is inappropriate to force food by nagging or other pressures. What about all those blood draws so that laboratory records can chart a patient’s decline? Perhaps one can ask the health care provider to consider an order that says no more blood is to be taken if no treatments will be given regardless of lab results. Often, there is agreement for no more blood draws but routine takes on a life of its own. The role of health care proxy is serious and potentially a very heavy obligation. In many cases, it goes beyond just making the decision that “comfort measures” are to be taken. It requires the proxy to advocate for the patient and struggle with the “right” way to do what the patient would have requested could he speak for himself. Not easy. www.wnycaremanager.com back to top back to table of contents Current Issue | About Forever Young | Where to Find | Advertise | Our Advertisers | Community Calendar | Contest | Clubs | Contact Us | Archives | Home |
