No one likes to ponder their own mortality. In many cases individuals fail to make the necessary plans to deal with end of life issues. Their families, while dealing with the emotions of an often sudden mortal illness or injury, are left to make decisions without written instructions from their now incapacitated loved one. In such a circumstance the Alabama Natural Death Act provides for the appointment of a surrogate to make treatment and end of life decisions. Once two physicians have determined that the individual is incapacitated and has a terminal condition, a surrogate is appointed by on the following order of priority:
- Court appointed Guardian
- Patient’s Spouse
- Adult Child
- Adult Sibling
- Relatives of the next closest degree
- If no relatives are known or none can be found, a committee composed of the patient’s primary treating physician and the facilities ethics committee. The committee must notify DHR and allow review of any decisions.
It should be noted that a Court appointed Guardian lacks the authority to make end of life decisions unless that power is specifically granted by the Court in the appointing Order.
Once the surrogate is appointed, they are empowered to make decisions regarding end of life issues such as types of medication, surgery, food and water provided through tubes, blood transfusions, cardiopulmonary resuscitation (CPR) and mechanical respirators.
The best policy, as always is to plan ahead for every eventuality. Rather than letting their fate be determined by a committee of doctors sitting in a conference room, everyone should have an advanced directive. An advance directive includes written instructions to others about medical treatment and health care the individual would want when they cannot articulate those wishes. It enables an individual to appoint a proxy to speak for them if they are unable to make decisions, and it provides instructions to treating physicians which cannot be voiced at the time. An advanced directive provides peace of mind to all parties and avoids conflict over what others believe to be your wishes or in your best interest.