Medical Crisis: When Nothing is in Writing

When healthcare decisions aren't in writing and there are no medical powers of attorney readied beforehand, what happens to the patient? Who steps in and makes decisions on their behalf? If you have not preplanned by signing a medical power of attorney, those decisions may be made by someone you would otherwise not have chosen.

Keep control in your hands by signing a medical power of attorney, called an Advanced Medical Directive. That way, you make clear your healthcare decisions, before a major incident occurs. You exercise your right to name a person of your choosing to advocate for you. That way, if you suffer an accident or health care crisis, at least you may rest assured knowing that your wishes concerning medical treatment will be fulfilled.

If you don't prepare in advance, then by default you are subject to state laws that dictate who will make health care decisions on your behalf. Generally, this may involve going to a hearing where a healthcare surrogate or agent is named to act on your behalf. In Maryland, we are governed by the Health Care Decisions Act, which states that surrogates are named in the following order:

- A legal guardian of the patient
- Spouse or domestic partner
- Adult child of the patient
- Parent of the patient
- Adult sibling of the patient
- Friend or other relative

However, if there are no other agents available in the previous tiers and a friend or other relative is appointed, they will have to complete an affidavit stating that they have had "enough regular contact with the patient so as to make the surrogate familiar with the patient's activities, health, and personal belief."

If a surrogate is appointed, that person is expected to make decisions based on the patient's wishes, if known, or in the patient's best interests, which is also defined by the Act.

Would your child know your medical preferences? Would your best friend? Your parent? It is possible for a person in the list of surrogates to decline to be your agent if they feel they aren't an appropriate choice or are otherwise unsuitable to the task, which means the agency would be passed to the next in line. An advance health care directive is crucial to preventing misunderstandings as well as disagreements as to your medical care if you can't speak for yourself.

Read more about the Health Care Decisions Act at the MD Attorney General's website: http://www.marylandattorneygeneral.gov/Pages/HealthPolicy/hcda.aspx