I recently had the opportunity to read an article in a professional journal on health-care decision-making during a crisis when nothing is in writing.  It discussed a study that interviewed physicians and other health care providers caring for people who had not named a health-care decision maker and did not have the capacity to make their own health care decisions.  In some states (but not in Massachusetts), state law will dictate who becomes a surrogate decision-maker when the incapacitated person has failed to do so. In most cases that person is the spouse or next of kin.  However, that surrogate may have no idea what the ill person’s wishes are or that surrogate may be the last person the patient would have chosen (think estranged spouse or child).  In other circumstances, family members may disagree on care options.  The most difficult situations are patients without immediate family to make health care decisions for them who had not designated someone else to do so.  In many cases, it was unclear whether the decisions being made were reflective of the patient’s wishes. The article underscored the importance of doing the following:

• Sign a Health Care Proxy that names the person you want to make health care decisions for you if you are unable to do so and at least one back-up decision-maker.  Ideally, this is someone who you see and speak with often, and with whom you have had an opportunity to discuss your wishes on more than one occasion.
• Make sure the contact information for your Health Care Agents is correct in your Proxy, and keep it up-to-date.
• Give your Health Care Agents and your physician a copy of your Health Care Proxy.
• Keep a copy of your Health Care Proxy on your smart phone so that it is easily accessible in a crisis and ask your Health Care Agent to do the same.
• Communicate your care preferences to your Health Care Agents, either in conversation or in writing.

On the last point, there are many useful tools that can be found online to assist in this conversation.  I have listed a couple here:

• www.theconversationproject.org

• The Proxy Quiz from the ABA Commission on Law and Aging