February 6, 2018
Mrs. A was a Howard County resident, suffering from advanced dementia. She had three children, who qualified as her legal surrogates. However, Mrs. A never began a conversation about her health care wishes with her family. She had not named any of her children as her health care agent, leaving doubt as to who would make specific important decisions about her care, should she not be able to.
Two of her children wanted her to die a natural death without mechanical or artificial support. One wanted her to be put on a feeding tube. By the time the family had to figure out what was best for her, it was too late to know what she would have wanted. Because Mrs. A did not declare a health care agent and there was no agreement among her children on her care, the default action was to attach a feeding tube to Mrs. A. When families disagree, the hospital has no choice but to do whatever they can to prolong the patient’s life. Mrs. A bounced in and out of nursing homes before her death. Her life became more uncomfortable and it created stress amongst the immediate family.
“An advance directive would have saved the family the burden of making this decision,” said Leslie Rogers, who has dedicated the past 23 years of her career to serving the community as a social worker. She has spent the past nine years with Howard County General Hospital and currently serves as the director of social work, chaplaincy and cancer support services. Her work focuses on helping patients and families plan for and decide on the care they would want to receive if they were suddenly in an emergency or critical care situation.
Those decisions are never easy to make, but they are made a lot simpler when people have had conversations about their wishes and named a health care agent that doctors and providers can speak with.
By naming a health care agent to make those decisions, it relieves patients and families of the stress that comes when it’s too late and ultimately makes situations more comfortable for everybody, Rogers says. The health care agent develops an understanding of what the patient wants when not able to make a decision themselves and then puts a plan into place.
“Far too many times in my career, I’ve seen undue stress put on families that have not had these conversations or prepared to make these decisions,” said Rogers. “Conversely, the peace of mind that families find when they know the decisions result in what the patient wants is what makes my job so special. Helping them get to that point is really satisfying. The hospital is not concerned with any specific treatment choice. We just want patients to be able to have a voice when they no longer have one themselves.”
Rogers recalls one patient who had made sure to establish his health care agent and advance directive. Mr. S was a man in his mid-50’s with newly-diagnosed advanced stage cancer. With a grim prognosis, he was confined to a bed at Howard County General Hospital. His girlfriend of several years was his support system. They had lived together for some time, but they were not married. He had been separated from his wife for a decade, but never divorced.
Because Mr. S had identified his girlfriend as his health care agent while he was still able to communicate, his care decisions were made by her – as he wished. Otherwise, those decisions would have been made by his estranged wife, creating unneeded confusion.
“It gave him a great amount of relief that he would save his ex-wife lots of drama,” said Rogers. “Because of that, he was able to die a peaceful death.”