Question

Consider a situation in which a 62-year-old, self-identified lesbian who has been in a committed relationship with her same-sex partner, has been involved in an accident and is unconscious. She has been estranged from her biologic family for most of her adult life. Her most significant relationship has been with her partner and her partner's biologic children. The patient is intubated and has been on a mechanical ventilator for 7 days. Her attending physician would like to perform a tracheostomy. Who, if anyone, can make health care decisions for this patient and why? Support your answer with evidence.

Answer 1

People who are decisionally incapitated are the most powerless, marginated members of the society. The health care decisions often made on their behalf are biased,arbitrary, corrupt or careless. In many cases the people they engage as their surrogate decision maker may not be of family origin. He/she may be their same sex parner. Such couples have to maintain a durable power of attorney for health care instrument which can be used in emergency. In nearly all states, without the valid document, the lesbian couple is not legally permitted to make health related decisions. These documents are known as Advanced Care Planning (ACP) documents which gives right to the lesbian to prefer her partner as alternate decision maker at the end of life.

In the above scenario where the 62 year old lesbian is admitted in health care setting and the decision for trachoestomy have to be made, the decision about performing tracheostomy can be taken by the same sex partner only if she has ACP documents available. If the documents are not available, the biologic family members are to be informed. As she has been estranged from their biologic family, they may or may not wish to participate in the decision making on her behalf. In such case where the biologic family also does responds then the health care team leader i.e the concerned physician have the right to make necessary health related decision on her behalf.