We advise all of our clients to execute a health care proxy appointing an agent to carry out the client’s wishes about health care in the event she cannot do so for herself. Our documents include a medical directive to provide some guidance to the agent about the client’s wishes regarding end-of-life care, whether or not to “pull the plug.”
We also advise clients to talk with their health care agents about their wishes and point of view. We also tell them about workbooks, such as Five Wishes, which can help them to provide more detailed information to their agents.
But even with these discussions and guidance, agents are often left having to make difficult decisions where the medical outcome of available procedures is uncertain. This quandary is highlighted in Your Medical Mind: How to Decide What is Right for You, a book by doctors Jerome Groopman and Pamela Hartzband. The recommend that, before deciding what you want, consider whether you are a strong believer in the power of medicine and technology, or a doubter who trusts nature and thinks medical care often does as much harm as good. Are you a maximalist who want the most care possible, or a minimalist who prefers to avoid even Tylenol? (Paraphrasing a review from The Boston Globe.)
The problem, of course, is that none of us really knows the outcome of particular medical procedures. Groopman himself reports having been skeptical when his mother chose to try an experimental cancer drug, which in fact gave her 14 more months of quality life. His experience reflects the fact that even medical specialists cannot be certain about the effects of specific treatments for specific individuals, making the health care agent’s decisions ever more difficult.
A contrasting example is that of the mother of a friend who chose to end her debilitating treatment at a Boston hospital, ready to pass away at home on the Cape. Instead, she had several more years of relative good health.
In other words, telling your health care agent whether to take a maximalist or a minimalist approach to medical care provides some, but not complete guidance. Every situation will be different with no guarantee of the outcome. That said, unfortunately, most people provide little or no guidance to their agents, so this is an excellent place to start.