When Others Make End of Life Choices

On the How We Die website, clinical bioethicist Viki Kind discusses her role on a hospital “advocate team”, that makes decisions about end-of-life when a patient has no advance directives, or family or friends to help guide these decisions.

One of the hardest things for me to witness is when a patient has no one to speak for them at the end. We call this person the unrepresented patient or the unbefriended person. This is someone without any friends or family who can make sure they have a good death.

So what happens to them? In some cases, a public conservator or guardian is appointed to make their decisions for them. This is a stranger making decisions for another stranger. There is nothing personal or meaningful in this process.

If there isn’t a guardian available, a group of people at the hospital will make the decision for this person. Sometimes we call this an advocate team or a moral community. This group usually consists of a doctor, nurse, social worker, chaplain, members of the ethics committee and community members. As a group they will make the decision whether someone should live or die. Unfortunately this decision is based on very little information about who the person is or what is important to them in their life. It is usually a medical decision instead of a human decision. Not that the advocate team doesn’t try to make it personal.