Question

How has the current responsibility for health-care decisions changed from the past?

Answer 1

Health care decisions are the responsibility of each individual with legal capacity the right to determine his or her own health-care.  The right includes refusal of treatment that would clearly sustain life.

When a person lacks legal capacity, the issue is much more obscure.  Parents of minor children and guardians appointed by the courts for children and adults who lack legal capacity may usually be relied upon by health-care providers as substitutes for the individuals themselves.

In 1982, the Uniform Law Commissioners promulgated the Model Health-Care Consent Act, which addressed the broader issues of consent to treatment, but stopped short of addressing the problems of the dying patient. In 1993, in a further effort to spur uniformity, the Uniform Law Commissioners have promulgated a comprehensive, third-generation Act that solves both the broader problem of health-care decision-making and the narrower problem of who decides when to withdraw treatment, allowing a patient to die.

When a patient is incapacitated and unable to provide informed consent, health care providers in the past have faced a great deal of uncertainty regarding who could make medical decisions on behalf of the patient. This particularly has been an issue when a patient hasn't designated a legal representative and the family members disagree on the best course of action. However, recently legislation passed hospitals and other health care providers with clear guidance on what to do in these situations. While not specifically covered, the new law appears to permit individuals who fit specific criteria to make decisions regarding affirmative health care treatment (such as authorizing surgery), as well as decisions to terminate treatment, including life-sustaining treatment (such as discontinuation of a ventilator).