Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
End-of-Life Issues
Questions and Answers
Healthcare Decision Makers at the End of Life
Case: EMS receives a call for an 85-year-old female who had an unwitnessed fall at a skilled nursing facility. The patient has a past medical history of lung cancer with metastasis, chronic obstructive pulmonary disease (COPD), and dementia. The nurse assigned to the patient called 911 after she heard a loud noise from this patient’s room and ran in there to find the patient getting up off of the floor with a small laceration to her forehead. The patient states that she “feels fine” but does not remember falling despite the laceration to her forehead and is only oriented to person, but not place, time, or context. The patient’s daughter, who was also called after this event, arrives and asks that her mother not be taken to the emergency department, stating that the patient has a durable power of attorney for healthcare that designates her as the attorney-in-fact.
1
What is capacity?
Capacity refers to the determination that a person has the ability to make decisions for themselves. The four elements of capacity are having an understanding of the decision to be made, having an appreciation of the possible outcomes of said decision and how it applies to one’s circumstances, having the reasoning ability to deliberate between the options, and the ability to express a choice. Capacity is dynamic and may change with time such as patients with dementia or advanced medical illness.
2
How is this different than competence?
Competence also refers to the ability to make decisions but is decided upon by a judge as a legal decision. As determinations of competence are made within the court system, they are less dynamic than capacity. In the prehospital and other healthcare fields, we evaluate for capacity rather than competence.
3
What is a durable power of attorney?
Power of attorney is a legal order designating a person (designated as the attorney-in-fact) to make decisions for another person (referred to as the principal) in the case that they become incapacitated. This can be for all decisions in a person’s life including financial or business decisions. This may also be only specifically for healthcare decisions.
4
What is a healthcare proxy or healthcare surrogate?
A healthcare proxy or surrogate is someone who is appointed by you to make medical decisions. This can be someone that is designated by the patient themselves when they had the ability to make decisions such as in a power of attorney. This can also be someone appointed after they lose the capacity to make decisions. The process of who becomes designated as the healthcare proxy varies widely from state to state. Some states have a set hierarchy of people that become the default healthcare proxy if one isn’t designated by the patient prior to incapacitation.
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here