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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.

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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 objects.

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

Reviewed on September 23, 2003

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