Generally, you will be required, as far as possible, to make the same
medical decisions that the patient would have made. To do this you might need
to examine any specific statements that the patient made (either orally or in
writing, such as in a living will), as well as consider the patient's beliefs
If you have no information about what the patient would want, you must act
in what you believe would be in the patient's best interest, using your own
judgment. To arrive at that decision, you might ask the patient's doctors what
kind of benefits and burdens might result from the treatment; you can draw on
knowledge that others have about the patient and on their opinions; or you can
ask others what they would want if they were in such a situation. However, the
more you and the patient have talked, the less likely you will be in the dark
about what the patient would want.
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Normally the agent becomes the decision maker after the attending physician
determines that the patient either temporarily or permanently lacks the ability
to make health care decisions. Many states also require that a second physician
confirm the patient's incapacity if the decision involves withholding or
withdrawing life support treatments.
What do I need to know to make decisions?
You need to gather as much information as possible about the patient's
condition. What is wrong with the patient (the diagnosis)? What is likely to
happen to the patient because of the disease or medical condition (the
prognosis)? If the doctors are unsure of the diagnosis or prognosis, you need
to know when they will know more and what they are doing to get more
Sometimes the process of obtaining information involves invasive and
uncomfortable testing, and you will need to decide if the process should go
forward. For example, you may know that the patient would not have wanted
invasive testing, or you may decide that the burdens of testing and or
treatment outweigh any likely benefits.
Therefore, information about the patient's prognosis is particularly
important. What, given the present situation, is the most likely outcome?
Although the outcome may never be known absolutely, you can ask what chance the
patient has to return to his or her previous condition, or if that is not
realistic, what is the best outcome that could be expected? The worst?
If the doctor says the patient may improve with treatment, what does
"improve" mean? To a doctor "improve" might mean survival, but
with serious brain damage. You may know that the patient would not want
treatment if that was the most likely outcome.