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Acting in the best interests of the patient

Naming health care rep vital to fidelity to end-of-life wishes

I honestly don’t remember the last time I talked to my father. It’s been in the last couple years ... I’m pretty sure. And when did we have our last meaningful conversation? About things that are important and valuable to us? It’s probably been since the 1990s. I don’t think there’s any anger, there certainly isn’t on my end, but over the years since I left home, we’ve just realized we don’t have anything to talk about.

I honestly don’t remember the last day that I didn’t talk to my wife, Liz. She has been my constant companion and understands me far better than anyone else. She’s far better than I deserve. It’s for this reason that I have explicitly made her my health care representative. But if I, like so many Hoosiers, had not gone to the trouble of explicitly making her my health care representative, here’s what could happen.

Let’s say that on my way to work, I get into a car accident that leaves me unconscious, in a coma. And let’s say that my prospects are bleak – there are real questions about the value of aggressive treatment. Who, then, would get to decide about my future? According to the Indiana statute that governs decisions for incapacitated persons, Liz and my father would have equal say over my medical care. In Illinois, they have a rigidly ordered list and my wife would come first, no questions asked. In Indiana, the statute (IC16-36-1-4) lumps together “a spouse, a parent, an adult child, or an adult sibling.” If Liz thought one treatment was the best for me and my father disagreed, neither would have legal standing to overrule the other.

I’m sure that the health care team, Liz and my father would all try to resolve such an impasse. They would try to reach an agreement. But if they could not? Liz, who knows me so well, who cares for me like no other, would have no more standing than an estranged family member.

Doctors, nurses, and social workers throughout Fort Wayne encounter this kind of story all the time. When I talk to them about it, they often refer to the “brother from California” or the “black sheep on a white horse.” An estranged family member thinks he or she knows what’s best for their father, mother, sister, brother or child. And Indiana’s Code gives them the same legal standing as every other family member, whether you like it or not. Unless you assign a health care representative. So here’s my advice to you: Assign a health care representative. Today.

Three simple steps can get it done. First, identify the individual you believe would make the best decisions if you can’t make decisions for yourself. Second, get a health care representative form (if nowhere else you can find one at Third, sign the form in front of a witness (who shouldn’t be the person you’re assigning as representative).

One more thing – assigning a health care representative has become even more important now. During the last legislative session, Indiana made the Physician Order for Scope of Treatment (POST) form a binding document in Indiana. This form adds weight to the values of patients and their families when decisions are made at the end of life. In many cases, this form is much easier to use when you’ve already assigned a health care representative.

If you have questions about assigning a health care representative or would like to find out more about the POST form, Keith Huffman and I will be leading a conversation at noon on Nov. 20. You’re welcome to join us. For directions, information, and to RSVP, please contact Aging & In-Home Services of Northeast Indiana at 260-745-1200.

Abraham Schwab is a medical ethicist and assistant professor of philosophy at IPFW. He wrote this for The Journal Gazette.