I'll kill the suspense by saying in advance that everything went perfectly (Thank you, NY Presbyterian!). Though I've discussed healthcare proxy before on this blog, and though as an elder care social worker and geriatric care manager in NYC, it's something I've discussed with countless clients, this was my first time ACTING as a healthcare proxy for someone I know.
A day before the procedure, I realized I was going to make a very poor healthcare proxy for this person. Why? Because that piece of paper with my name on it meant absolutely nothing, zilch, nada, unless I knew specifically what the wishes were of the person designating me. They did not have a living will, which would have outlined the type of care they would like to receive should they become incapacitated. I didn't know if they were a DNR or so-called "full code". I didn't know what sort of heroic measures they might or might not want taken. I didn't know their hydration or nutrition wishes should they become incapacitated. In short, filling out a healthcare proxy form is a nice start, but in the absence of an executed living will, it is not enough.
So I pulled this person aside and had that conversation. Amazingly, it wasn't something they even put much thought into. They assumed (incorrectly, and perhaps dangerously) that I was some sort of mind reader, and would just know the right thing to do. The truth is, there is no right or wrong way to handle these things. It's all a matter of opinions and values. A good healthcare proxy asks these sorts of specific questions. A great healthcare proxy knows about the values and personality of the person they might have to represent.
Here are some examples of specific questions to ask of the person appointing you healthcare proxy:
- Do you want to be resuscitated should you stop breathing or if your heart stops ("full code") or do you want to be listed as do-not-resucitate (DNR)? The default option at hospitals, unless you specify otherwise, is full-code.
- Do you want to be hydrated and fed if you have a catastrophic outcome and have little chance of recovery?
- How important is pain management to you?
- Would you want to be kept alive "artificially" with a respirator, for example?
Of course, it can be difficult to ask questions like these. If you are a healthcare proxy and haven't asked these specific healthcare scenario questions, at least find out what sorts of things matter to the individual you're representing. Ask what they like to do. Ask what sorts of things they don't like to do. Ask their opinion about things like death and dying, or aging, or healthcare in general. Ask about a time in the past in which they've been in great physical pain and how they handled it. What worked? What didn't? To not have these answers as a healthcare proxy can result in decisions being made that the patient never would have wanted for themselves.
Luckily, I didn't have to enact my authority as healthcare proxy this past week. But I am so glad I'm prepared should I have to fulfill this role in the future. I also feel like I know this person even better than I did before, which is a real gift.
Be in touch if you have questions about this topic, or need help discussing these issues with your loved one.