Medical Decision Making in the COVID-19 Era
Choosing a medical decision maker to voice your care preferences in the time of need
Reviewed by: Elizabeth Kvale, MD, MSPH
Written by: Ashley Lawrence
Medical decision making is hard enough under the best of circumstances, but in the midst of a global pandemic, preparing for medical decision making is critical for everyone. If you do find yourself in an emergency situation, you have the power to control who makes medical decisions on your behalf and what your care preferences are. While these conversations may be uncomfortable, having a plan in place not only helps your healthcare providers, but can also alleviate some of the fear and anxiety you or your loved ones may be experiencing due to the ongoing public health threat.
“Since the start of the pandemic, we’ve seen increased volumes of patients in the hospital and oftentimes people haven’t talked to their loved ones about their preference for care or what limitations they want put on their care. With the uncertainties surrounding the current COVID-19 outbreak, now is a great time to initiate that conversation,” says Elizabeth Kvale, MD, MSPH, who serves as both Medical Director for UT Health Austin’s Livestrong Cancer Institutes and Director of the Supportive Care and Survivorship Program at Dell Medical School.
Choosing a Medical Decision Maker
A medical decision maker is a designated person who makes medical decisions for you only when you are too sick to make medical decisions for yourself. You want to choose a family member or friend that you trust to carry out your care preferences.
An ideal medical decision maker is:
- A family member or friend
- At least 18 years of age or older
- Comfortable speaking with you about your care preferences
- Comfortable speaking with your doctor about your care preferences
- There for you when you need them
“There are some patients who don’t have family members that they trust,” reveals Dr. Kvale. “However, they may have a close friend, neighbor, or colleague that they view as a clear thinker or feel they can trust to make decisions on their behalf.”
Asking Someone to Be Your Medical Decision Maker
Never assume someone knows you want them to be your medical decision maker. Instead, make time to sit down with that person to discuss what being a medical decision maker means for them, why you want that person to be your medical decision maker, and what your care preferences are.
When asking someone to be your medical decision maker:
- Choose a quiet place and time to bring it up
- Make sure the person isn’t distracted and understands what you are asking of them
- Give the person time to think about it before moving forward
- Understand that the person may say no
“One challenge is that patients come in without knowing who should speak for them,” reveals Dr. Kvale, “but another challenge is that patients come in without recognizing what sorts of decisions can be made on their behalf. You could find yourself in a situation where you have a tube down your throat and your designated medical decision maker will have to, quite literally, speak for you, and who you choose must be able to be your representative in that situation. This is why it’s important that you choose someone carefully, someone who will do what you want and not make decisions based on what they want.”
Informing Others of Your Decision and Care Preferences
After someone agrees to act as your medical decision maker, be sure to share with them your care preferences. This is the time to discuss what matters most to you, whether that be living as long as possible, evaluating your quality of life, or a combination of the two.
Once you’ve chosen a medical decision maker, you should:
- Notify your healthcare providers of your chosen medical decision maker
- Tell your family and friends about your care preferences and who your medical decision maker is
- Inform your medical decision maker of your care preferences
- Complete a Texas Medical Power of Attorney, designating your medical decision maker (the form is free to the public, doesn’t require an attorney, and also available in Spanish)
“When you pick someone to be your medical decision maker,” explains Dr. Kvale, “you need to tell them. If you just write their name down on a form, but don’t give them any indication of your care preferences, you’re putting them in a tough situation where they have to make difficult decisions for you with no information to rely on. Telling your loved ones what your preferences are is an act of care, because they don’t get stuck in a place where they have to live with decisions they made for the rest of their lives.”
If you’d like assistance with outlining your care preferences or initiating a conversation with your potential medical decision maker, this five-part tutorial can help you get started (available in both English and Spanish). If you’d like to learn more about services available at UT Health Austin, call 1-833-UT-CARES or visit here.
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