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Healthcare Surrogates and the Role They Play in the End Life Care Treatment

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Healthcare Surrogates and the Role They Play in the End Life Care Treatment

Healthcare Surrogates and the Role They Play in the End Life Care Treatment

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Definition of the Term

The term healthcare surrogate is related to the end life care treatment of an individual, most often an elderly patient. It is a designated title that is given to a competent adult who is responsible for making healthcare decisions on behalf of a patient who is damaged due to illness.

The responsibilities of a healthcare surrogate are diverse. It includes applying for public benefits on behalf of the patient to enable him to pay the cost of healthcare, getting the patient admitted in a hospital or getting transferred from one facility to another, be it a nursing home, home care or any hospital.

Alternatively known as health care proxy, a healthcare surrogate is an advocate of the patient that makes important decisions about personal care of the patients. The importance of healthcare surrogate is that elderly person lying at hospitals often found in a condition when they are not able to make decisions regarding their health. Moreover, it is also noticed that many times the family members are also not able to make decisions confidently. So in such situations surrogate decision making is inevitable and necessary.

healthcare surrogate

This healthcare decision making could be done entirely by the surrogates or sometimes jointly by the patient and the surrogate. They usually confront with a lot of decisions in both the intensive care units and the hospital ward setting. The hospitals are bound to accept the role played by the surrogates and to support them when they make significant decisions about the patient for example, such as removing life support.

The patient can himself choose a healthcare surrogate through the medical power of attorney in a legal manner in ahead to achieve better care and treatment at the end of the years. The healthcare surrogate is authorized by filling out the Designation of Health Care Surrogate form. For the purpose, it is advisable that the patient should discuss his wishes reading his treatment and care with the surrogate in advance. Because in case the surrogate is not aware of the interest of the patient he or she would make decisions keeping in mind the best interest of the patient.

This concept of healthcare surrogate comes under the advance directive principles stated by the law of the country.

Advance directives are a written statement where a person states how he wants his medical decisions to be realized in the due course of time. Some do it in the wake of their deadly illness while some healthy people do it as part of their estate planning.

The Florida healthcare surrogate law is also called Advance directives that talk about these healthcare surrogate professionals. The state of Florida has its legal advance directives. It is written in chapter 765 of Florida statutory obligations regarding advance healthcare directives. This law recognizes the right of an adult to prepare advance directives in the presence of his physician to provide or withhold the treatment or in extreme situations can withdraw life support. It also states that the patient can designate another person to do the same on behalf of him. Moreover, the law also makes it clear that you need not necessarily have to be incompetent to choose a healthcare surrogate.

Do You Know 27 Percent of The Americans States that They Have Not Given Proper Thought to This Aspect?

Yes, they have given little thought about how their end of life care should be materialized. So in the absence of advance care directives, they rely on their respective state’s default surrogate statutory regulations. These regulations usually grant a person or some selected type of people to make healthcare decisions on behalf of the patient.

Advance Directives in the USA, A Statistical Analysis

As stated by the American Journal of Preventive Medicine in the year 2014, only about a quarter or 26 percent of the people has an advance directive in the form of a living will.

•    As per statistics that were done in the year 2017, more than one-third of the US adults enjoy an advanced medical directive or a living will. The same study says nearly 37 percent of the Americans have prepared their advance directives especially for an end to life care. Another fact pointed out by this research is that almost half of the American people enjoying living wills are not suffering from chronic illness.

•    A total of 150 studies conducted between 2000 and 2015 talks about the completion of advance care directives in the USA. The participants were both healthy and sick, and it has found that 36.7 percent of adults completed an advanced directive of some kind. Among the population, 29 percent has living wills, 33 percent had health care powers of attorney, and 32 percent had undefined advanced directives.

It has said those elderly patients and those who are receiving care while suffering from a severe illness like cancer are expected to have advance directives. Those end-of-life cares are commonly found with patients suffering from dementia. It is less common with people infected with HIV/AIDS. What is clear from this study that only a meager portion of the population has the willingness to go for a consensus on end of life treatment and it is really surprising.

The proponents of advance care planning are of the view that the legalities involved in the mater should be removed so that it helps the completion of the process and bring some flexibility into the matter.

Eligibility for the Position

An individual adult who is of 18 years old and above can be a healthcare surrogate. The patient should ask the surrogate in advance if he would like to act before making advance directives or living will. The patient is also allowed to find the second alternative in case the first surrogate is not available.

The patient must sign the Designation of Health Care Surrogate form or can have someone else signed on behalf of him at your instruction. The process should be witnessed by two adults. Most importantly, your witnesses cannot be your designated surrogate. One witness should not be your blood relative or your spouse.

Powers and Limitations of a Surrogate Professional

Surrogate healthcare must use substituted judgment in the process of decision making on behalf of the patient. He or she may refuse or consent to the healthcare of the patient. Though in practice, the surrogate is bound to act in the best interest of the patient irrespective of the fact whether he is appointed by the court or the patient. In case of absence of a living will the healthcare surrogate can use this substituted judgment based on what the patient would desire in such situations. This process requires further discussion with others who know the patient for a long time. Several states have formulated measures to prevent any misuse of the power of a surrogate and the subsequent suffering of the patients.

Challenges Involved in Surrogacy Decision Making

Despite the legal enforcement in this matter, some evaluations are necessary in this regard such as whether the decision of surrogates can reflect a family or cultural values, whether the decision of a surrogate demonstrates the patient’s values and how to formulate a more accurate decision-making process.

When a surrogate is hierarchically appointed, little importance is given on the collaborative decision-making process. The family surrogates often face challenges in understanding the possible healthcare options so that they can make a well-informed decision which represents their loved one’s values and goals in life.

Does the Patient Have The Right To Decide?

As per rule, every patient has the right to make decisions relating to his or her health, and it includes the right to choose or refuse any medical treatment. When the person is not in a condition to do this, the primary physician has the right to decide the course of treatment.

What Happens When a Patient Fails To Name A Representative For Himself?

In case the patient fails to choose a representative he should make a living will to state his wishes about his medical treatment. But it is always preferable to choose a healthcare surrogate when the patient is in the best state of health so that no confusion arises in the last days of treatment.

The Florida Healthcare Surrogate Law Has Entrusted the Doctors to Choose From the Following List of People in the Absence of a Healthcare Surrogate

The guardian of the patient

•    The spouse of the patient

•    His adult children

•    His parents

•    His adult brothers and sisters

•    His relatives who know the patient well and his wishes

Usually, in the United States, such an agent is chosen by the current physician or advanced practice registered nurse. The hierarchies of healthcare surrogates are varied from state to state, but in most cases, these people are picked up. When lots of such people are available within the priority category, a consensus is reached among them about who will take care of the patient.

In the absence of any of this someone else can be designated by the hospital ethics committee after consulting with the doctors. 

A patient also must fulfill specific criteria to be able to select a healthcare surrogate. He must have any disability such as mental illness or any impairment that restricts his ability to perform daily routine activities, or cognitive degeneration or lack of all the people that are listed above. However, the state of Florida is an exception here because one can choose a designate without suffering from any illness. 

Final Insights

Promoting end life care has been a significant concern in the country since the days of Medicare, the national health insurance program for older adults over 65. It started reimbursing physicians in the hope of improving advanced care planning counseling. The effort is to how to widen its reach so that more and more seniors could enjoy the better end of life treatment.

Healthcare for the elderly in America is an ongoing concern. The growing number of senior American adults has raised enormous concern for medical professionals and the healthcare planning advocates. The number of Americans with chronic diseases is also showing an alarming rate. Hence it is necessary that the patient’s families and physicians should get into effective communication about the healthcare and end of life care of the patients. No doubt, a healthcare surrogate from a quality provider would make things easier to manage.


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