Every day, caregivers’ minds are occupied with everything from medication schedules to symptom management. And, of course, they must remember to take care of themselves.
The idea that they should have to add legal concerns to their already overflowing cup seems almost cruel. But understanding the laws intended to protect them can help them to avoid some of the causes of caregiver stress.
Christine Marsick, MD, medical director of Visiting Nurse Association of Ohio, said caregivers – or adult children who may not yet be caregivers – should talk with their loved ones about what they want for their care while they are still able to make those decisions for themselves. These conversations should answer questions including:
- Who should speak on the person’s behalf in the event that he cannot speak for himself? When that person is chosen, conversations should still continue with the rest of the family, so everyone understands the patient’s desires.
- How far should doctors go to revive the person if her heart stops or if she stops breathing? Should a breathing tube be inserted? Should CPR be given?
- Should treatment at the end of life be concerned with prolonging life by whatever means necessary? Or should treatment focus on symptom management aimed at ensuring comfort and the best quality of life.
“Having these conversations can be very hard, because you have to acknowledge your mortality, and a lot of people don’t want to do that,” said Marsick, who also holds a law degree and has an interest in medical ethics and health policy. “The biggest protection in terms of making decisions is to try to get everyone on board or at least in the same room discussing things.”
Once decisions are made, legal documents should be put in place to formalize them.
- Advance healthcare directive or living will indicates what sort of medical care, such as life support, a patient wants to receive should he or she become permanently unconscious. This document also often names a health-care proxy, also known as a durable power of attorney.
- A durable power of attorney gives an “agent” the authority to make decisions on behalf of a person who is incapacitated. These decisions include what sort of treatment will be given, what physicians will provide that treatment and where the treatment will be carried out. This agent also has the authority to make end-of-life decisions including when life-sustaining treatments should be withdrawn. This document only goes into affect when the patient can no longer make his own decisions, as determined by his physician. “If you don’t have this document, (healthcare providers) will just go to the next of kin,” Marsick said. “The most important thing to think about is who knows the most about your wishes and who knows the most about your healthcare.”
- Do Not Resuscitate document is exactly what it seems to be. This order on a person’s medical chart tells physicians and other healthcare providers that the patient does not want life-sustaining measures to be performed in the event that his heart stops or he stops breathing.
- A will names the individual who will execute the person’s estate after his or her death. This document also identifies the deceased person’s beneficiaries, or those who will inherit from the estate.
“The best thing you can do for your loved one is to really try to understand what they want,” Marsick said. “If you don’t know, ask.”