Case Study 23 : INCOMPETENT ADULT’S PROXY
Challenges
A 72 year old female was admitted due to fever that began four days prior to admission. On admission. The patient had a fever of 37.8ºC and hypogastric and right lower quadrant tenderness. Initial laboratory examination revealed pyuria, leukocytosis and hypoalbuminemia. CT scan of the lower abdomen showed multioculated, multiseptated fluid accumulation with dense wall in the pelvic cavity. On the fifth hospital day, the patient lost consciousness.
The attending physician explained to the family the patient’s condition and need for surgery. The patient’s husband agreed, while the children, who will help defray the expensed, refused due to apprehensions that their mother might die, given that her sister expired a few months earlier after an abdominal surgery.
Question
Who decides for the incompetent patient?
Solutions
Legally speaking, the following order applies to determine the incompetent adult’s proxy: (a) legitimate spouse, (b) adult competent children, (c) ascendants in the direct line, i.e., grandparents, whether on the paternal or maternal side, (d) brother or sister, and, (e) guardian, whether appointed by the court or not.
However, in some cultures, other immediate family members oftentimes play a decisive role in the care of patients, including decision-making, especially when they help pay for medical expenses. To save time and effort, the easiest scenario for the doctor involves talking only with the proxy, though taking with the rest, especially if the proxy requests so, would be most helpful.
At any rate, the proxy should relay all relevant medical information and ethical principles to other close family members concerned, to arrive at a unanimous decision as much as possible. A unanimous decision strengthens family ties, and helps all focus efforts in caring for the patient, and lessens misunderstandings that could later lead to guilt feelings and even blaming.
