Medical Decision-Making for Older Adults

without Family
Barry D. Weiss, MD,* Elena A. Berman, PhD,* Carol L. Howe, MD, MLS,
and Robert B. Fleming, JD

I chose this subject because is an important activity in daily medical practice and as
doctors we must be aware of the variety of options for this people.

Everyday around the world the number of older individuals uncappable to make decisions
for themselves is raising, those without family, friends or someone that can make health-
related decisions for them become the ones receiving care that would not have been their
preference resulting in higher healthcare costs and probably more aggressive treatments
than individuals with family or friends.

This situation can be the result of acute or chronic illness, is estimated that 16% of older
individuals hospitalized in ICU lack of family or designated surrogates who can make main
decisions related to their health, and usually clinicians must wrestle with uncertainty about
best approaches to care, I am agree when author says people want their medical
surrogate to be someone who cares about them and who will be aggressive in promoting
their desires is because this, that the majority of older individuals hold their trust in family
members even without giving explicit instructions about their preferences, but for those
without family this is not a option.

Although there are several approaches addressing this situation, all of them have
limitations, some examples are: PHYSICIANS MAKING DECISIONS: even though the law
may preclude them from serving as surrogates, many physicians and other health
professionals often make decisions for the people under they care, but consistency among
physicians is lacking, physicians are just as likely as others to project their own thoughts
and values about quality of life when making decisions for others and they are financially
rewarded for procedures and interventions what can add bias to their decisions.
HOSPITAL ETHICS COMMITTEES: convening meetings of these committees quickly and
having them come to a timely consensus about health-related decisions often makes their
use impractical. STATUTORY RULES AND COURT-APPOINTED SURROGATE AGENTS:
several of the states with surrogacy statutes sharply limit their applicability, such as only for
participation in research or other discrete purposes so this prevent them from effectively
make decisions for individuals without family. POPULATION-BASED TREATMENT
INDICATORS: a new approach that has been suggested but not currently in use is a
computer-based system that predicts the preferences of an individual who lacks decision-
making capacity by examining his or her background, furthermore, some have argued that
allowing a computer to make such decisions would be a denial of a persons freedom.
HEALTH FIDUCIARIES: a professional certified who acts as surrogate decision-maker for
individuals who become unable to make decisions for themselves, these professionals
encourage older adults to prepare advance directives while they are well and have good
mental function, health fiduciary was provided as a standard service under Medicare, but
is a service not available for those without health insurance.
Decision making for older adults without family is a complex situation, in consequence:
1. Advance directives can provide clinicians with a sense of the individuals desires
and preferences for medical care.
2. As health professionals, we must follow the protocol that our institution provides us
for such situation.
3. Health Fiduciaries is for me the best approach addressing decision-making for
older individuals without family.