I’m going to throw this question out there while setting aside the legalese and differences between the individual states. It’s a very general question, and I hope I can adequately paint the picture that I’m trying to get across. I’d like to know what you think, if you’d so kindly humor me.
Sometimes, an elderly patient who is no longer able to make competent decisions has a Durable Power of Attorney for Health Care that was drawn up at some point in the past, usually naming their adult child(ren) as Attorney(s)-in-Fact, or in some cases, even a Conservator appointed to handle their affairs, including health care decisions. Most of the time, the people making the decisions on the patient’s behalf clearly are interested in making decisions in the best interests of the patient and look to us for guidance regarding treatment and transport decisions. There is usually no problem at all.
However, once in a while, such agents don’t make decisions that are in the best interests of the patient, and they refuse treatment and/or transport on the patient’s behalf, which they are legally authorized to do as the Attorney(s)-in-Fact or Conservator(s), even when it is plainly obvious that treatment and/or transport is/are necessary.
(Let’s leave issues regarding resuscitations out of this post for the sake of this discussion.)
Now, there are mechanisms in place to challenge the decision-making abilities of an Attorney-in-Fact or a Conservator, but these are typically after the decision in question has already been made, long after the call is over.
So, what do we do on the scene of the dispute?
And, more importantly – this is the main point of this post – when does poor decision-making cross that line and become neglect and/or abuse? For example, should an agent be allowed to refuse transport, unchallenged, on behalf of a demented patient with an apparent ongoing infection with no obvious evidence of any prior treatment or even a Plan B?