Planning ahead on health care
Our ongoing ability to decide for ourselves what health care we want, and what health treatment we will accept, is easily taken for granted. It is hard to even imagine the circumstances in which we would be unable to communicate our needs and desires to others.
However, such things happen everyday – with accidents around the home, automobile accidents, and medical events such as heart attacks or strokes. We can suddenly go from being healthy, independent and confident in our ability to take care of ourselves, to complete dependency on others. If we have not made our desires and needs known to those around us ahead of time, there is no way those desires and needs will be carried out.
It is therefore only wise to think ahead, and make arrangements assuming that such a common thing could indeed happen to us. Hopefully it never will, but if it does we have our desires and needs set down carefully in writing and known to those around us.
Enduring Guardian. One option for preparing for this worst-case scenario is to have someone be appointed as an ‘Enduring Guardian’. The minimum requirement for a guardian is that it should be someone over age 18 who agrees to be appointed to make personal, medical, lifestyle and healthcare decisions for you if you are no longer able to do so yourself. It is even possible to appoint several Enduring Guardians to have responsibility over different areas of your life.
The procedure for appointing an Enduring Guardian requires that you must do so in writing using an approved form. As this is a legal document both you and the appointees must sign the document in the presence of a NSW legal practitioner or a registrar of the local court, for a fee.
In choosing your Enduring Guardian it is better that it be someone who would not benefit from your will, as that puts temptation in the way of your trusted family members. Over and over the courts see sons, daughters, cousins, and others who have been guilty of bilking their dependent’s resources for their own benefit.
A good rule of thumb recommended by Dr Moyes is to think about the gifts you have received at Christmas from the person you are thinking of appointing your Enduring Guardian. Do the gifts suit you to a tee, recognise who you are and how you see yourself, do they fit your lifestyle and interests, and worldview? Or are the gifts always embarrassingly inappropriate items that you wonder how you can get rid of, eg femme fatale clothes when your wish is to join a convent, sporting equipment for the family brain, a biographical dictionary for the party girl? The selection of gifts reveals a lot about how clearly a person can truly see who we are.
Advance Care Directive. Another option is an Advance Care Directive, which is a written statement that you complete with information about your health care preferences. There is no set template or format. The NSW Department of Health recognises these as extensions of the individual’s right, under the common law, to decline medical treatment.
But think very seriously about what you write. If you do become incapacitated you might actually change your mind about not wanting to be kept alive with machines, for instance, but not be able to say so. You could watch in vain as they unplugged your life support system as you requested. So be very thoughtful and careful about what you ask for!
Once you are confident you have recorded what you would really want them to do if you were dependent, review it yearly to keep it up to date, and make copies to keep with you in case of accident. Always take a copy of it when you are admitted to the hospital.
Person Responsible. NSW law provides that decisions about your health care fall to the next person responsible, and this may not always be the same as the next of kin. The first person responsible will be the Enduring Guardian; if you lack that then the most recent spouse, de facto, or same sex partner with whom you have a close and ongoing relationship. If there is no one who fits that description then it falls to an unpaid carer who is providing support. If there is no one like that then it falls to a relative, or even a friend. The authorities do not know about our relationships, so it is in our best interest to specify exactly who we would want to be considered the person responsible.
Enduring Power of Attorney and Wills. These are legal documents and do not involve your health care, but are worth doing. An Enduring Power of Attorney allows you to appoint a person to make decisions about your property or financial affairs. And a will directs the distribution of your property upon your death.
It is very hard to imagine ourselves affected by trauma, illness or disability to the extent that we could not tell others what we wanted, but it is an important exercise. Planning ahead will be of great help to those who may one day be called upon to make decisions on your behalf.
