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    Importance of a Health Care Representative

    Anna Dauer, MD Deaconess Palliative Care 08/13/2018
    Here at Deaconess, family members and loved ones make decisions on others’ behalf every single day. Sometimes the situation is sudden, such as after a car crash. In other situations, a family member has been in a gradual decline. But in all circumstances it can be a difficult time, so having the right information, with the desired decision-makers, is crucial.
    Because of my work with palliative care, the idea of having a designated health care representative is very important to me and something I think everyone should do. To help you better understand what a health care representative is, what they do, and how to select one, I’ve summarized the key points below.   
    What is a health care representative?

    A health care representative is a person who has been named as the health care decision-maker for another person. That means you chose a specific person to speak for you in the event of an emergency and/or if you’re too sick or injured to speak for yourself about the type of care you want.
    Sometimes people appoint a power of attorney for health care decisions, but in Indiana, simply naming a health care representative is enough.
    The selection of a health care representative can be done verbally, but I always recommend that people document this decision and share it with their doctors. Also, you don’t have to see a lawyer to identify your representative—you can get the form online, or ask your doctor.
    Who can legally make medical decisions for you?
    Until recently, in the state of Indiana, if you were unable to make decisions for yourself and you didn’t have a health care representative, first-degree relatives would make decisions on your behalf. That means your spouse, parents, adult children and adult siblings would all have had input. 
    The law has changed, and now there is a hierarchy of decision-makers. 
    If an adult incapable of making their own health care decisions has not appointed a health care representative/power of attorney for health care, consent for health care may be given in the following order of priority:
    1. Court appointed guardian
    2. A spouse
    3. Adult child(ren)
    4. Parent(s)
    5. Adult sibling(s)
    6. Grandparent(s)
    7. Adult grandchild(ren)
    8. The nearest other adult relative
    9. An adult friend who has maintained regular contact with the individual and knows the patient well  
    While this hierarchy does make sense to me, every family is different. Choosing someone you trust, who knows you well and will speak for you, can give you peace of mind. 
    The House Bill 1119 Fact Sheet contains more details about this new law.
    POST Form 
    A POST form – Physician Order for Scope of Treatment – ensures that a patient’s wishes are honored by providers at any point of care. The patient keeps a copy of this form at home so EMS or other first responders know how to treat them. A copy should also be on file with the patient’s physician(s). At Deaconess, we enter these forms into our electronic medical record system so doctors can see it at any time.
    A POST form can include directions that can prolong life and/or provide comfort care. It’s a very customizable form because it’s completed by a doctor, nurse practitioner or physician assistant; it can be updated as needed.
    Completing a POST form is an important activity to do with your doctor. It provides an opportunity for you and your physician to discuss what level of care you would—and would not—want to receive.
    You can find these forms for Indiana at the Indiana Health Care Quality Resource Center.
    Most important things to remember
    • Patients make their own decisions as long as they are able. We do not activate the health care representative until the patient can no longer make decisions.
    • Decide what YOU want, and put it in writing. 
    • Share your wishes with your loved ones and chosen representative.
    • Give a copy of your documents to your doctor and/or hospital. (Your Deaconess physician’s office or our Medical Records Department located at Deaconess Midtown Hospital can scan them into our electronic medical record system at any time.)
    Trying to make decisions for another person based upon what you think they would want is an emotionally draining process. By writing down your choices for medical care before you are sick or injured, you save your family and friends from having to make extremely difficult decisions.
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