Question: Who makes my health decisions if I am unconscious or in a coma?
From: Wendy H. of Webster, NY

Answer: Many of us remember the agonizing situations in the Quinlan (1976), Cruzan cases (1990), and more recently, the Schiabo cases which brought to light questions about right to refuse life sustaining treatment and the need to make your wishes known ahead. If you have been hospitalized in recent years, you have probably been asked if you have a Living Will or Advance Directive. Advance Directives may be written or oral directives made by an individual capable of making informed and voluntary decisions about treatment options for the possibility that he/she will be unable to express those choices. The Patient Self-Determination Act of 1990 mandated that patients be informed of the option to document treatment choices in an Advance Directive. An individual may designate someone to make or carry out wishes. Despite the publicity surrounding the above cases and information provided to the public, many do not have Advance Directives. In the absence of such documentation, clinicians in most states turn to surrogate decision makers. States recognize a relationship hierarchy to follow and to make treatment decisions the patient would make if he/she could. Surrogates are usually family members and loved ones but, in some cases (there is no family or they are not close), the surrogate may be a companion, neighbor, clergy member. Most states support the right of the family to authorize treatment or refusal of treatment based on the patient’s probable wishes and prior instructions. The obvious problem is when there is no clear indication of the patient’s wishes. Hospitals have an Ethics Committee made up of physicians, nurses, clergy, or others working closely with the patient. The Ethics Committee will assist in situations where there is no surrogate or they disagree. Guardians may be appointed by the court but this is not an immediate decision.

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