Doctor Disagreements – What Do I Do?
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If I don’t agree with the Doctor, what do I do? We’re focusing on doctor disagreements when the senior is in the last years of their life. Decisions that involve (1) prolonging life for only a few years and (2) with no or limited improvement in the quality of that life. Hastening death because you don’t want to live a healthier and prolonged life is not covered.
As seniors in our last years, decisions about health become very personal. Doctors want to make people better and they have an ever-expanding bag of medical techniques to intervene. As the doctors get better at keeping older seniors alive, we (seniors in advanced old age) tend to lose our cognitive and physical capabilities. It’s an interesting set of cross-currents that often leads to longer but poorer quality lives. It also leads to doctor disagreements.
Decisions I Make, Decisions I Make For Seniors
With seniors, there are two main areas where this comes up: decisions that I want to make and decisions I want to make for someone else. Let’s take them one at a time.
Doctor Disagreements – My Care
The United States Constitution and the court’s interpretation of the constitution have made it clear that the individual has total control over decision-making concerning life-sustaining medical technologies. This right also extends to medical interventions, resuscitation, medication, and physical therapies. If you don’t want it, you don’t get it.
Let’s be very clear. The Doctor says to you, “I want you to do [fill in the blank].” As long as you’re competent, you can tell the Doctor, “I don’t want to do [fill in the blank].” There shouldn’t be any enduring doctor disagreements.
The law supports your decision. If a doctor, hospital or other health care professional forces their will on you, they’re likely to face civil and even criminal liability.
For seniors, making decisions arise when we become temporarily or permanently incapacitated or incompetent to make decisions. When this happens, how can you disagree with the doctor?
Legal Ways To Get Care You Want
Surprisingly, states and the courts have anticipated this and give you a lot of options. You can make your will known in a variety of ways. These include Living Wills, Community DNRs, Advanced Care Medical Directives, Physician Orders for Life-Sustaining Treatment, Five Wishes, and Medical Power of Attorneys. Many do the same or similar things, and others are unique. CarePlanIt covers all of these in detail. All these documents embody techniques to ensure that your wishes are followed when you become incapacitated. See our Section on Advance Medical Directives in End of Life Chores.
Doctor Disagreements – Care Of Others
When you disagree with the doctor over how they want to treat someone else, the doctor will look at a couple of things. First, the doctor will ask if you have the patient’s medical power of attorney. A medical power of attorney with you named as the agent allows you to make medical decisions on the patient’s behalf. As a patient’s agent for medical decisions, you can tell the doctor what the patient wants when the patient s incompetent or unable to make their wishes known.
Advance Directives Will Be Followed
If you’re not the patient’s agent for medical decisions, you can certainly bring your concerns to the doctor. However, if you can support your concerns with the patient’s properly executed Living Will, Community DNR, Advanced Care Directive, Physician Orders for Life-Sustaining Treatment, or Five Wishes the doctor will thank you and follow the patient’s wishes as explained in those documents. If you’re not the patient’s agent and don’t have any patient executed end-of-life directives, you’ll have to resort to other techniques.
When a seriously ill senior or one of advanced age without advance directives arrives at a hospital or an emergency room, physicians will search out stakeholders. In this case, stakeholders are family members or caregivers that can give the physician some insight into the wishes of the senior.
Doctors Will Discontinue Medical Interventions Under These Conditions
In situations where (1) the physician does not believe that medical interventions or life-sustaining medical treatment will improve the senior’s quality of life and (2) the patient’s family members say the patient is not interested in having medical interventions, doctors generally will not treat except for pain and comfort.
The more difficult situation is when the physician believes medical interventions will improve the senior’s quality of life, but the patient’s family members say the patient is not interested in having these interventions. Without some legal document from the patient or the patient’s family, it’s likely the physician will need to act. They may do so only to minimize liability for failing to act. Here’s the issue: seniors have decades to put in place advance directives. When they don’t, it gets difficult to assume the seniors did not want their life preserved when quality could also be improved. Said a bit differently, if the senior wasn’t interested in living as long as possible, as long quality of life was the same or a bit better, why didn’t they put something in place to let people know their true wishes.
Minimizing Doctor Disagreements
As seniors, if we let people know what types of medical care we want, the less likely we’ll have disagreements with doctors and family members.
See our Section on Advance Directive Documents.
Minimizing Doctor Disagreement Based On Poor Information
There are many situations when a senior wants a type of care based on bad information. Bad information can come from a variety of places including the following:
There is a good discussion of these issues here.