Sick, Unconscious and Without Family, Friends or Surrogates--What's Next?
OK..here's the deal: You are in a hospital sick..you are unconscious..you need to have a surgical procedure done to attempt to make you better to some degree but you are unable to weigh the risks and benefits or to give the surgeon permission to operate..you are unconscious. In addition..you have been homeless..you have lived on the street..different streets..you have no friends..you have no relatives..you have no one to come to the hospital to visit you or talk to your surgeon. The surgeon wants to make you better..he or she needs to operate..but there is no one..not you or anyone else to give the surgeon permission. There is no law where the hospital is located which would instruct anyone what to do under these circumstances..Should the surgeon act as a family member or legal surrogate and make the decision for you? If you really were that patient..what do you think would be legal and ethical.. what would be the fairest act for that doctor to do for your benefit? Should the surgeon make the decision for you? And what if the decision to be made was not simply to operate to attempt to make you better but involved a decision to stop all life-supportive treatment because your condition was hopeless and you would never recover. Who should make that decision? You can't..you are unconscious and you have no one to speak for you. Got the picture?
By the way, this scenario is not at all rare. It can happen every day in some hospital. Most states in the U.S. have no laws which tell doctors what to do under these circumstance. Sure, the doctor and hospital can take the problem to the courts and have a judge decide or to have a legal guardian appointed. But this takes time and there may be no time. The guardian will not be available to respond for every single medical procedure nor will the guardian be free of conflict of interest or free of pressure from the judge when it comes to terminating life-support. So the doctors and hospitals have to make up their own guidelines. But my question is ..what would you want them to do if a patient comes in with no capacity to make decisions and no friends, family or surrogates to help with a medical decision? ..Maurice.