April 8, 2016
What’s the quickest way to make a young adult to roll his or her eyes? Start talking about the need for a health care proxy, a legally designated decision-maker in the event of an accident, illness or other serious medical crisis. After all, only older people need to think about this seemingly remote possibility, right?
This reaction by young adults is a perfectly natural form of denial. But as a physician, I know how crucial it is to have conversations about our wishes with loved ones and to take the extra step of naming a health care proxy, even if you’re barely over 18. In my travels around the New York region hosting CHAT (Conversations: Health and Treatment) sessions with college students and others to educate them about the complexities of modern health care decisions, the most common question asked is, “Why do I need a health care proxy? I’m young and healthy.”
April 16 is National Healthcare Decisions Day, an annual initiative to encourage us to name someone to be our health care proxy. This year’s theme, “It Always Seems Too Early, Until It’s Too Late,” deftly points out that this designation is often — and almost universally among young adults — put off indefinitely because a health care crisis “can’t happen to me.”
Recently, I received a frantic phone call from the mother of a college-age son who had been in a skiing accident 1,500 miles from home. She asked why her son’s doctor, in an emergency room in Colorado, wouldn’t tell her what was happening with her 20-year-old, who’d suffered a concussion and was taken down the mountain to a hospital. The doctor was upholding patient privacy laws and was unable to share details because he didn’t know who the young man’s health care proxy was.
Many people uninvolved in medicine may think a health care proxy — or any form of advance planning — is needed for “end of life,” but that’s too narrow a focus. The nature of medicine in the new millennium — presenting so many more treatment options that didn’t exist even 50 years ago — make this need apparent for adults of every age. Older people may be in declining health and deal with more chronic illnesses, but younger people often suffer devastating injuries or health crises for which they’re unprepared that prompt questions about how they want to live long-term. Suppose you need a ventilator? Kidney dialysis? Care in a rehabilitation center or skilled nursing facility? Advances in technology have brought more complex treatment options that demand someone who can act on your behalf who understands your values.
You might not know how or when to broach the subject of health care decisions with loved ones, so take a cue from current events or news stories. A good example is the sad case of Bobbi Kristina Brown, singer Whitney Houston’s 22-year-old daughter who died in July after being found unresponsive in a bathtub six months before. While tragic, Brown’s situation also generated controversy because of her prolonged coma and elaborate life support treatment. This case and others like it are ideal moments to reflect and tell others what you’d want done for you if you were in that situation.
What qualities should you look for in a health care proxy? Pick someone who understands your values; lives close by; can separate facts from feelings; can work with a team; is able to make peace; and, most of all, can act on your wishes.
Policy changes could make this process even easier for individuals to act on. I propose that hospitals mandate anyone entering for an elective procedure or surgery to complete a health care proxy form, no matter their age. Also, every university should require new students to complete such a form as a preventive health care measure.
While enforcing such policies might be tricky, the form itself is quite simple. The state Department of Health offers an easily downloadable health care proxy form at www.health.ny.gov/forms.
Maria Torroella Carney is chief of the Division of Geriatric and Palliative Medicine at Northwell Health in Great Neck and an associate professor at Hofstra Northwell School of Medicine.