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Revisiting the Question: Advocate and Proxy, Too? Making Decisions for Clients
Two years ago we asked whether a health/patient advocate can also be a decision-maker for her client in the form of being a healthcare proxy (the patient-designated person who makes end-of-life decisions for the patient, based on wishes the patient has legally documented). Since the ethics and standards of the original advocate role very specifically state that an advocate WILL NOT and CAN NOT make decisions for a client, would the new role of proxy create a conflict-of-interest? The scenario shared was that “Gwen” had been Mrs. Smith’s advocate for a long period of time and they had developed a close relationship. Mrs. Smith, at the age of 90, wanted Gwen to be her healthcare proxy to help determine (if necessary) when it was time to allow Mrs. Smith to die, instead of conceding to the healthcare system’s attempts to keep her alive at all costs. Read: Health Advocacy Ethics – Conflict of Interest? Or Important Service? Could those two roles be performed by the same person? We didn’t answer the question. Instead, we used the opportunity to develop a best practice by asking for input and opinions from those in practice at the time. The question: Should Gwen become Mrs. Smith’s healthcare proxy? Can she ETHICALLY make that shift? And the results were… (drum roll please!)…. 409 total votes: • 211 agreed that Gwen can ethically be Mrs. Smith’s healthcare proxy • 198 said that no, she cannot ethically make that shift Fast forward to 2016 when the question was asked again. Only this time it was not a fictional scenario. It was a question that came to us from a member of the Alliance about a real potential client. This time the client (we’ll call him Mr. Sanchez) is in his late 60s, single with no family, few friends (who he believes will die before he does), and a family history of stroke. Mr. Sanchez wants to find an advocate to help him develop his end-of-life wishes and documents, then be the person who carries them out by making decisions for him when the time comes. The advocate’s question…