One possible way to appoint proxies is to establish your own Medical
Care Decisions Committee (MCDC). This is a
committee consisting of 3 to 5 people who know you best and who agree with your medical ethics.
(An MCDC is not an
institutional ethics committee. Ethics committees
are established by hospitals, nursing homes, etc. to review medical
decisions and/or set health-care policy. These committees
are an important part of the health-care system. But they usually
have no personal knowledge of the patients prior to reviewing
their cases. Your
individualized Medical Care Decisions Committee might have
occasion to consult with an institutional ethics committee. But your MCDC is a
group of family and/or friends whom you legally
empower to make your medical decisions for you.)
When medical decisions are made by only one individual, there is always
room for second-guessing. This applies to
doctors, judges, spouses, or adult children. Any one person
acting alone can make a unwise choice. But when several
people jointly reach an important decision, their choice is
more likely to be in your best interest. And more respect
will be granted to a carefully-constructed MCDC than to a spouse
or an adult child making a medical decision alone. When one person
acts alone—even if that person is the patient— others can always
question the wisdom of that person's choices. And individuals
acting alone often do reach foolish decisions —distorted by
powerful emotions or misunderstood medical information.
Creating an MCDC is one way to include several of your adult
children instead of having
to select just one and exclude the others.
A group of wise
adults is less likely to be swayed by irrational
forces (such as fear, despair, depression, or pain) than an individual
making medical decisions alone. You might become
irrational when suffering a serious disease and/or confronting
your own death. You can protect
yourself from your own irrationality by appointing a
committee of wise relatives and friends to make your
decisions for you when your thinking might be impaired. And the decisions
of such a committee are more likely to be honored than your
possibly-distorted decisions when you are dying —or when you might
have become a former person.
You might be able to participate in the
deliberations of your MCDC in some degree. You might not lose
your mental faculties all at once. Your proxies will
hear and weigh your current views, asking how well
those views correspond with your Advance Directive, which you wrote
when you were fully able to make medical decisions.
When your decision-making abilities are questionable, you might be
invited to participate in the discussions the way a child
might be included in such decisions. A child would be
informed as much as possible. And the parents
would get some guidance from the child. But the parents
have the final power to decide for a minor child.
Your family and friends—who have known you for years— are best able to
grasp the fullness of person you have been. Your natural
parents have known you since you were born. Your siblings have
known you for most of your life. Your spouse or
other partner has known you for a certain number of years. And each of your
friends has known you for a specific period of time.
Once you have listed everyone who has known you long enough, you narrow the
list to the people who agree
with your medical ethics. Different
generations often differ about medical decisions. People born in the
first half of the 20th century might be more
inclined to follow whatever the doctors suggest. But educated
people born after the Second World War might find it
easier to challenge medical authority and to decide for
themselves —drawing on
professional medical opinions as much as seems wise.
If you have developed your own medical ethics, you should discuss
these perspectives and values with the people
you are considering for your MCDC. What do the
prospective members believe about the right to die? about the right to
withhold and/or withdraw life-supports? about the right to
choose a voluntary death? about the right to
grant a merciful death?
One of the best ways to confirm these agreements is to write a
detailed Advance Directive for Medical Care. Then prospective
members of your MCDC should comment on the medical
ethics embodied in your Advance Directive. Those who agree
most closely can be selected to enforce your decisions. And the others can
be respectfully excluded from your MCDC.
YOUR LAST YEAR: CREATING YOUR ADVANCE DIRECTIVE FOR MEDICAL CARE