As children, we relied on our parents for guidance, encouragement and direction. We also depended on them to make decisions for us – what clothes we would wear, what food we ate, what schools or religious organizations we attended, etc. Hopefully, our parents made those decisions with our best interests in mind to ensure smooth transitions through the childhood life stages. For most of our young childhood, our parents spoke for us.

As we aged through adolescence and young adulthood, we began to stretch our boundaries and flex our independent decision-making muscles. We learned to speak for ourselves and make choices based on our values, beliefs, likes/dislikes. We chose our friends; we determined our hobbies; we made meaning of our lives. And we grew into adulthood, we continued to make our own choices about careers, relationships, and our futures. Sometimes we made good choices; other times, not so good. But they were ours to make and we lived through whatever consequences followed.

We Americans pride ourselves on having and making our own choices. Some of us do diligent research and weigh every option before making a decision. Others make decisions based on how things make us feel or even on we expect others will feel. Regardless of what methods we use to make our decisions, the point is that they are still OUR decisions, OUR choices.

Why, then, are so many of us hesitant to continue on the path of making our own choices for future healthcare treatment? Is it because we are afraid to confront the fact that we will die someday? Is it because we assume that talking about our future death will upset those we love? Or, is it that we consider ourselves too young or too healthy to have to worry about this now? Whatever our reasons for NOT having these conversations and writing down our decisions, there is one very important decision we should ALL make – sooner rather than later:

“Who will speak for me?”

In the Commonwealth of Pennsylvania, there is a hierarchy of surrogate decision-makers that hospitals and healthcare professionals will follow if you are unable to communicate. That hierarchy, followed in particular order is:

1. Spouse (unless a divorce action has been filed)
2. Parents
3. Adult Children
4. Siblings
5. Friends
6. Healthcare professional (not optimal)

Honestly, many people may be comfortable with this decision-making hierarchy and feel confident that their loved one(s) will make decisions as if they were making them for themselves. And sometimes, loved ones make decisions based on how they would feel in the same situation rather than how you, as the patient, feel. There are many complexities in these decisions and there are as many important considerations to be discussed and vetted. Below are a few examples:

• Will your loved one really be able to make decisions that you would make for yourself? If you do not want tube feedings under any circumstances, would your loved one be able to abide by your wish? Many of us equate food with love – preparing and providing food for our loved ones is seen as a nurturing, loving gesture. But, few people understand that tube feeding at the end of life may actually harm a dying individual.

• If you say “do everything to keep me alive”, would your loved one understand that you actually mean do everything only if you still know who you are and who your loved ones are?

Who will represent YOUR choices when you are unable to communicate? Who will really speak for you?

Caring Choices can help you consider who your most effective surrogate decision maker will be. Contact us now to schedule your conversation.

© 2013 Caring Choices