Understanding Your Health Choices: Conversations Before the Crisis
Biological family versus the chosen Family - Make your decisions known to your loved ones
We are entitled to make decisions about ourselves as long as we are
competent and can communicate. However, if we are not able to act, state law
will normally assign the decision-making to our next of kin. Medical staff and
others will presume, and in fact must presume, that this designation is
appropriate. But sometimes people have their closest relationship with a person
who is not a relative. This relationship might be friendship, or it might be
something more. This distinction is sometimes called the biological family and
the chosen family.
John and Robert had been partners for five years. The title to the house
they lived in was in John's name, although Robert contributed to the mortgage
payments. They had purchased most of the furnishings together, after combining
what they owned from earlier in life.
Your best-selling book The Year of Magical Thinking chronicles your grief
following the loss of your husband, John. What surprised you most about
I did not expect the degree of derangement-both physiological and mental. An
example of the latter: Two weeks after John died, when I filled out a hospital
form for the autopsy report, I gave not my own address but that of an apartment
in which we had lived for the first four or five months of our marriage, in
When John suddenly had a massive stroke at age 53, Robert discovered that he
did not have legal authority to determine the course of treatment. Although he
and John had talked about medical interventions and treatment choices for
serious illness, control slipped from Robert's hands.
After, he notified John's parents of the incident. The parents, who had a
civil but distant relationship with Robert, arrived at the hospital within 12
hours and directed the physician to maintain John on life support. Eventually
they moved him to a nursing home near their residence in Atlanta. When John
died, the parents sold the house John and Robert had lived in, and claimed most
of the contents. Robert was not only heartbroken over the loss of John; he was
left with no home and found himself in an ugly fight over inanimate
The same situation can confront opposite-sex partners, even partners who
have children together, if legal relationships have not been established.
Anyone in a nontraditional family needs to pay special attention to decisions
and arrangements for the end of life. The conversation that follows suggests a
way of giving legal power to a partner or friend.
"I've been worried lately about what would happen if one of us got sick.
I'd want you to make decisions about my care and help me if I needed help, but
you wouldn't have any legal authority. Would you be willing to consider taking
responsibility under a durable power of attorney for health care? It would make
me feel better."
"What about your parents? How would they feel about that?"
"I'm not certain, but I think I'd like to make this decision and then
let them know. They might be relieved, or they might be angry. We could tell
them about it when they come for Thanksgiving."
WebMD Medical Reference from the National Hospice and Palliative Care Organization