Over the next few months this newsletter will explore different aspects of medical decision making. Today we will look at decision making when the patient is not able to make his or her own medical decisions.
If a person is not competent to make their own medical decisions, and this lack of competence is documented by a physician, then healthcare professionals have to identify a surrogate decision maker. If there is not a Medical Power of Attorney, then Texas law tells healthcare providers who can make medical decisions.
At the top of the list is a spouse. If there is no spouse, if it's documented that the spouse is also not competent to make medical decisions, or if the spouse declines to make decisions, then next on the list are the adult children.
We first look to the adult child who has the waiver and consent of all other qualified adult children to act as the sole decision maker. This often happens by default, if there is an adult child who has been traditionally been the caregiver. At times, healthcare providers have to insist that children designate the decision maker, because it is confusing and difficult to have multiple children involved in decision making.
Sometimes all of the children are not available, so then we go to the majority of the patient's reasonably available adult children. There is no specific definition of "reasonably available", but if an adult child is not coming to the hospital, or they do not return multiple phone calls, they are not available.
If there are no adult children, next on the list are the patient's parents. If there are no parents still living, or if the parents are not competent to make decisions, we go to the person who was identified by the patient to make decisions, or the nearest living relative, or a member of the clergy.
As a healthcare provider, if you have a patient who will not complete a Medical Power of Attorney document, but they do tell you that they want a particular person to be decision maker, document this preference in the medical record.
Next month we will look at the Medical Power of Attorney document, which has had some changes made to it following the last legislative session.