What happens if you’re incapacitated and cannot make decisions for yourself? You may have discussed various scenarios that could arise that would require a family member to make such decisions, and they probably see eye-to-eye on what your choices would be if any of the various scenarios were to befall you.
Jump ahead to these sections:
- Consider Why You Do Not Want a Family Member to Make Your Medical Decisions for You
- Execute an Advanced Directive for Medical Care
There’s a very simple solution to resolve your concerns — you can execute an advanced directive.
To execute an advanced directive, there are two options:
- You can get a living will if you want to state your own preferences about your care.
- You can execute a durable healthcare power of attorney (also called a healthcare proxy or a medical power of attorney) if you want a family member to make your decisions for you.
However, what are your options if you do not want a family member to make decisions for you? You may be surprised to learn that your options are exactly the same.
Here are the two simple steps you should take to ensure that your family members do not make medical decisions for you.
Step 1: Consider Why You Do Not Want a Family Member to Make Your Medical Decisions for You
Someone else is likely to make your decisions for you when:
- You’re unexpectedly incapacitated — perhaps by a sudden injury or illness — and you’re unable to make decisions for yourself.
- You develop a gradual mental incapacity that overtakes your ability to make decisions for yourself.
Here’s why you may not want a family member to make medical decisions for you:
Conflict or disagreement
If you are certain that you do not want a family member to make your medical decisions for you when you’re unable to do so, it may be because you know your family members don’t agree with your decisions.
Maybe your family members have even told you they would not make the decision that you would prefer because they think you are wrong or unreasonable. In this case, it’s clear that your family members are not the right decision-makers for you.
Inability or unwillingness to decide
Maybe you’ve discussed these issues with your family members and they do not necessarily disagree with your preferences. They may even tell you that if they have to, they will make their decisions according to your stated preferences.
However, you just get the sense that when push comes to shove, they’re not going to have the fortitude and resolve or the emotional capacity to make the decisions you want them to. In this case, your family members are probably not the best candidates to make your medical decisions.
You don’t want to put them in that position
Many people simply do not want to put their loved ones in the position of having to make such difficult and stressful decisions.
You may know that this would cause much stress for your family and that they will feel guilty about their decision for the rest of their lives. You may not want to force your family to have to make those decisions.
There’s someone else you prefer
You may know that a very close friend is more likely to make difficult decisions according to your preferences. Your friend may know you so well and will be loyal to you, no matter what. You may neither disagree with nor doubt your family members, but you trust your closest friend to know what you would want. This may be a difficult conversation to have with your family, but discuss your decision with family members anyway.
No matter how different the reasons could be, the solution is the same for each scenario — you must execute an advanced directive.
Nevertheless, how you approach the subject with your family members may depend on your reasons for not wanting them involved. You should consider carefully why you feel this way and what may be the best way to avoid tension and unnecessary drama when someone has to make a decision on your behalf.
Step 2: Execute an Advanced Directive for Medical Care
The only way to prevent family members from having input on your medical care when you are incapacitated is for you to make your intentions known. You can do this by stating your own preferences for medical care in writing and making sure your physicians and healthcare providers know and understand your wishes. You would do this with a living will.
Alternatively, you can do this by designating someone else who knows your medical care preferences and will state your preferences on your behalf. You would do this with a durable healthcare power of attorney.
A living will is a legal document that states your preferences for various end-of-life medical procedures that you may or may not want doctors to use to sustain your life. This typically includes things like:
- Use of an artificial ventilator
- Tube feeding to provide life-sustaining food and hydration
- Cardiopulmonary resuscitation (CPR)
- Antimicrobial or antibiotic treatments
- Pain medication that may hasten death
Living wills allow you to indicate your own choices, but they are limited to the procedures and circumstances described in the living will. If you’re incapacitated and confront a circumstance or possible procedure that you did not anticipate and include in your living will, your medical provider would have no way to know what your choice would be.
Consequently, they would rely on either a health care proxy (if you designated one) or, most likely, your family members to indicate your choice for you. A living will offers you the most decision-making autonomy but can be limited in scope.
Durable healthcare power of attorney
A durable healthcare power of attorney is a legal instrument through which you authorize someone else to state your decisions for you under circumstances where you cannot make decisions for yourself.
This could be necessary when you do not have a living will or when you do have a living will, but are confronted with choices you did not anticipate and address in the living will. It’s always best to have both a living will and a durable healthcare power of attorney.
You designate a person you trust to state your choices for you with a durable healthcare power of attorney, even though their choices may differ from yours. You choose this person to “state” your preferences on your behalf, not to choose your preferences for you.
If there are choices that you have not anticipated or discussed, then you trust that this person will know what your choices would be and to state them, even though their own choices may be different.
Provided your living will and durable healthcare power of attorney are in writing and you signed them and provide them to your medical care providers, they are bound to adhere to your stated preferences, even if your family members object or choose otherwise.
If you do not have one (or both) of these two legal instruments to indicate your wishes, it’s likely that your medical care provider will rely on the input of your family members to choose the procedure or treatment that they want to be provided to you.
It’s Your Choice
Everyone necessarily chooses who they want to make decisions for them if they are incapacitated. There are only three options before your medical care providers (and possibly an ethics committee) decide for themselves:
- Your proxy
- Your family
You choose yourself by having a living will. You choose a proxy by opting for a durable healthcare power of attorney.
You choose your family by default. In this sense, you choose your family members by not choosing. If this is not what you want, then you must have a living will and a durable healthcare power of attorney.