Who Makes Medical Decisions If You Are Incapacitated?

It’s 2:00 A.M. when the phone rings. I answer it, groggily.
The voice on the line asks if I know Mr. Wallace. I do, but why is anyone asking me? Mr. Wallace is my former father-in-law. His late son and I divorced more than 20 years ago, and I have not seen the senior Mr. Wallace for longer than that. 
“Mr. Wallace is in the ER,” the voice says. “It appears he suffered a cardiac arrest. He is unconscious and in serious condition. Do you want us to enter a DNR (do not resuscitate) order?”
I should not be the one making this decision, and I certainly have no idea what’s wrong with him or what he would want me to do.
“But ma’am,” the voice persists, “you are listed as the agent under his health care power of attorney on file with this hospital. You are his surrogate decision-maker. We need a decision from you now.”
This woman is in an impossible situation. Does Mr. Wallace truly intend for his former daughter-in-law to make medical decisions for him when he cannot, even though he has not seen her in many years? Or did he merely forget to update his Power of Attorney when she and his son divorced? Did he ever prepare an Advance Directive, setting out his wishes for care? If so, he neither shared that document nor discussed his wishes with his former daughter-in-law.
As one might imagine, this woman feels wholly lost regarding Mr. Wallace’s desires for end-of-life care. She had no idea he designated her to make decisions for him.
Something went terribly wrong here.

Select a Medical Care Surrogate and Make Sure They Know Your Wishes

There are times when critical medical decisions for ourselves or our loved ones will fall into our hands. We optimistically assume we will be the ones making those choices.
But what if, like Mr. Wallace, we’re unconscious, under sedation, or have dementia and are unable to discuss the situation with the doctors and render a decision?
If this were you, and doctors needed a critical decision urgently, have you appointed someone who will make these medical decisions if you are incapacitated, and more importantly, does this person know what you want? 
Have you told your medical care surrogate what is important to you, what makes you happy, what gives your life meaning? Have your shared your attitudes about resuscitation, ventilators, feeding tubes, surgery, antibiotics, dialysis, chemo/radiation, hospice care, and all those other emotionally fraught procedures surrogates might face?
Mr. Wallace failed to have that conversation with his daughter-in-law. He unintentionally ambushed her with the responsibility to make vital medical decisions for him without providing any guidance regarding how she should go about it.

Don’t Put Off Making this Very Important Decision Regarding Your Medical Care

If you have not appointed someone to make medical decisions for you, you need to do so – and discuss with them your values and your medical wishes. Make the appointment and have this conversation sooner rather than later. Do not procrastinate.
You should not leave your surrogates adrift with all the responsibility, but none of the knowledge they need, to manage your care. That isn’t fair to them.
Provide your surrogate decision-makers with the knowledge and authority to communicate your wishes and instructions to your physicians, rather than asking them to make those hard decisions on their own. You will lift much of the burden from their shoulders and empower them to advocate for you.   
In today’s world of physical distancing, you can have that needed talk in-person, with surrogates in your household; by phone, with those further away; or even via e-mail, text, or Zoom.
The method doesn’t matter, but the conversation does.  

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