A health care surrogate is a person appointed through a legal document to make medical decisions for a patient who cannot do so independently. There might be an impasse between the family members regarding medical and health care decisions. It can lead to unnecessary delays in providing critical care. A health care surrogate is appointed to ensure such an unwanted situation doesn’t arise. This blog delves into the various aspects of a health care surrogate.
Essential Features of a Health Care Surrogate
The various features and characteristics of a health care surrogate are as follows:
- Authority: The designation paperwork grants the health care surrogate the power to consult with physicians, coordinate care, and make medical decisions on behalf of the patient.
- Activation on Incapacitation: The health care surrogate can engage immediately if the patient is incapacitated after the legal designation.
- Activation Before Incapacitation: It is still possible to appoint someone as the designated health care surrogate even if the patient is not incapacitated. Certain situations that demand the same are chronic illness or surgery, entailing longer recovery periods. The patient might have the mental capacity to decide on the medical procedures but not the energy to oversee the treatment.
- Advance Directive: A health care surrogate is a type of advance directive like a living will and power of attorney. Individuals have the option of combining different directives to customize their end-of-life planning.
Factors in Selecting a Health Care Surrogate
It is important not to appoint the health care surrogate prematurely. For instance, choosing whether to refuse life-supporting care might be challenging. The surrogate must possess the resolve and courage to carry out the given instructions despite the protests of other family members. Besides, the patient must have faith in their ability to follow the written directions.
- Location: The surrogate should be accessible and reach the place of need as quickly as possible, as health-related decisions are mostly critical and time-bound.
- Trustworthiness: The designated person should be trustworthy and can be easily relied on to carry out the patient's wish.
- Physical and Mental Ability: The designated surrogate should be able to provide long-term care to the patient on both physical and mental levels.
- Tenacity: The surrogate should be able to communicate with the health care professionals on behalf of the patient and have an unwavering commitment to them.
- Willingness: The person chosen as a surrogate must be willing to make decisions regarding medical care at any moment.
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Steps to Choose a Health Care Surrogate
The process of choosing a health care surrogate can be relatively easy or complicated, depending on state regulations.
- Follow the Legal Hierarchy. If a surrogate has not been registered for the patient beforehand through a written or oral order, many states allow selecting a health care surrogate via a hierarchy of surrogacy. This may not be the patient’s preference, but the common hierarchy follows husband/wife; children above 18 years of age; parents; siblings, and adult grandchildren.
- Seek Family Consensus. There might be a discrepancy in cases of multiple spouses and adopted children in a few states depending on the regulations and in case they lack a definitive hierarchy for the purpose of surrogacy. In that case, a family consensus is taken into account for making decisions on behalf of the incapacitated persons.
- Negotiate among Multiple Contenders. They must attempt to agree if multiple people are at that priority level. Sometimes it is impossible to come to a consensus. The physician will respect the majority decision of the surrogate decision makers (or the custodial parent). However, a guardianship procedure can be started by the minor (or the parent who does not have custody rights) to address the situation. Families may undergo a time-consuming and expensive guardianship process if a health care agent is not documented in advance or if someone with a lower priority level doesn't agree with the choice.
Steps to Appoint a Health Care Surrogate
Certain steps must be followed before the health care surrogate can act on behalf of the patient.
- Determine the Role of the Physician. A physician may decide that a patient who lacks capacity needs a decision made on their behalf. The physician must ascertain whether the patient has a legal capability plan if no strategy exists.
- Identify the Surrogate. The doctor must ascertain if there is an assigned surrogate for the patient. Only the surrogates designated through legal documents have the authority to make decisions. The doctor may follow the surrogate decision maker's decision per the law.
- Fulfill the Patient’s Wishes. The surrogates must try to fulfill the patient's wishes. Reviewing the patient's religious, moral, and ethical values is important. Surrogates might not be aware of these ideas and ideals. If so, the surrogates must choose based on what is best for the patient.
Authority and Responsibility of a Health Care Surrogate
In the majority of circumstances, a health care surrogate has the authority to make decisions on behalf of the patient in the following circumstances:
- Treatment: The surrogate can consent to treatments and medical treatment procedures, especially in cases of chronic and complicated treatment, which is carried on for a long period of time, even if the patient has the mental capacity to give consent but does not have the energy to deal with such minor processes.
- Organ and Tissue Donation: The surrogate can permit tissue and organ donations in case of the patient's death, provided proper documentation declares the patient's wish for donation beforehand.
- Defray Health Care Cost: The surrogate can apply for various health care schemes issued for the benefit of the public to alleviate the cost of medical expenses. With the health care cost at a perpetual high, it becomes difficult to pay off all the medical bills. It certainly cannot be expected of the patient to take care of these formalities. Hence, the responsibility falls upon the health care surrogate
- Transfer: The surrogate can decide on the admission or transfer of the patient from and to different medical facilities and institutions. Transferring a patient from one facility to another comes with a certain level of time and health risk, but the decision needs to be made for the purpose of better care and benefits available at the new facility.
- Limited Power: Limited powers might be granted by this document. For instance, if transfusions are against one's religious convictions, one could forbid the health care surrogate form from authorizing the transfusion. You, the grantor, are free to delegate to the health care surrogate as much or as little authority as you see fit in light of the circumstances.
Key Terms for Health Care Surrogates
- Advance Directive: A legal document that outlines a person's intentions regarding medical treatment if they become incapacitated due to a major illness or injury.
- Capacity: An individual's capability to ask another person to make decisions on one's behalf if one cannot make them oneself regarding one's medical care.
- Informed Consent: Providing essential details to the patient regarding a medical procedure, therapy, or any clinical trial. This aims to make the patient aware of all the potential risks and benefits of the procedures.
- End-of-Life Planning: It allows an individual to put forth their preferences in writing with respect to important medical care choices.
- Chronic Illness: Sickness that lasts for a prolonged period of time and deteriorates over time. Older persons are more likely to have chronic diseases, which are manageable but not cured.
Final Thoughts on Health Care Surrogates
A health care surrogate is appointed to make life-altering decisions for a person instead of a mere materialistic element like property or a house. The selection of the same must be done carefully. The designated person should have the person’s best interests in mind. This is important if there are no written instructions and the designated person has to decide autonomously. If the individual for whom the surrogate has been chosen already has a chronic illness, the surrogate should also have a basic understanding of medical language and the health care system. Being a health care surrogate can be emotionally challenging, and the surrogate needs to take decisions level-headedly despite the duress surrounding the situation.
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