August 29 • 2019 63
jn

T

he average age of an 
individual in an intensive 
medical care situation is his 
60s, according to Susan P. Shapiro, 
Ph.D., a research professor at the 
American Bar Foundation. For that 
reason, it’
s critical to designate a 
surrogate decision maker who can 
and will effectively advocate for 
desired medical care.
Many times, it’
s a matter of life 
or death.
“It’
s the ultimate decision,” 
said Shapiro, who resides in 
Buchanan, in southwest Michigan, 
and commutes to her job at the 
Chicago-based foundation. 
“It’
s the biggest life-and-death 
decision you can make,” she added. 
“On one hand, it’
s extremely 
important; and on the other hand, 
it’
s the most difficult decision to 
make. It grabs the family when it is 
least able to handle the situation 

Susan P. 

Shapiro, Ph.D.

and it takes the 
greatest resources 
that a family can 
have.”
Shapiro, who 
attended Detroit 
schools and 
graduated from 
Southfield High 
School, has recently published 
Speaking for the Dying: Life-and-
Death Decisions in Intensive Care 
through the University of Chicago 

Press. She holds a bachelor’
s degree 
from the University of Michigan 
and a master’
s degree and Ph.D. in 
sociology from Yale University.
For the book, Shapiro examined 
the interactions between doctors, 
surrogate decisions makers and 
families of patients who were 
brought into the ICU of two urban 
hospitals in the Chicago area. One 
was an open neurological ICU and 
the second was an ICU in which 
doctors dealt with conditions not 
involving brains or hearts. 
In all, she and a research 
assistant studied approximately 
1,000 cases involving this medical 
dynamic to fully understand 
how doctors communicate with 
family members about life-and-
death situations and how families 
respond and make decisions about 
care for their loved ones.
“Most of the patients in the study 
had not named their legal decision 
makers,” Shapiro said, adding 
that the medical decision process 
becomes easier when an individual 
designates someone to make those 
decisions on his behalf. 
Creating a health proxy 
directive (also called a durable 
power of attorney for health 
care or designation of a patient 
advocate) doesn’
t require a lawyer 
or notary. Hospitals typically have 
proxy directive forms for free, and 

forms are also available online for 
free.
Shapiro noted she was surprised 
to find that for almost half of 
patients with advance directives, 
those directives made no 
discernible difference in easing the 
decision-making process or helping 
to clarify the patient’
s wishes.
Among the remainder for whom 
the directive did make a difference, 
she said, it was at least as likely to 
result in undermining the patient’
s 
wishes as in honoring them. 
“It is rarely possible to anticipate 
the complex choices at the bedside 
in documents drafted when 
patients are still healthy,” she said.

CHOOSING THE RIGHT 
SURROGATE DECISION MAKER
Shapiro enumerated qualities 
to consider when choosing an 
individual you can entrust to 
make life-or-death decisions 
on your behalf. Some of those 
characteristics include choosing 
an individual who knows you very 
well and understands your values, 
preferences and fears. Surrogate 
decision makers also need to be 
good listeners and communicators, 
intelligent, open-minded and 
decisive. They must also be able to 
process complex, incomplete and 
sometimes conflicting information 
and see the larger medical picture. 

She has recommendations for 
those tasked with making medical 
decisions for a loved one in the 
ICU. 
“It’
s extremely important to be 
around when the physicians are 
around,” she said. “Be there from 
day to day and talk to the doctors. 
Surrogates obviously need to be 
prepared to make decisions, and 
they need to have had a lot of 
conversations with the patient.”
On the part of hospitals, she 
recommends they designate 
specific individuals who can 
serve as intermediaries between 
surrogate decision makers, families 
and medical professionals and can 
help families navigate what is often 
a heart-rending decision. 
And, if faced with a particularly 
challenging medical decision, 
families can and should call upon a 
hospital’
s ethics committee.
“That’
s an important resource,” 
Shapiro said. “They do an 
incredibly good job in helping 
families with decisions. Often, 
it’
s not offered to families, but if 
you ask (to speak to the ethics 
committee), it’
s there.”

LOCAL RESOURCES
One Metro Detroit-based 
organization that can provide 
Jewish families with guidance 
on making medical decisions on 
behalf of their loved ones is the 
Jewish Hospice and Chaplaincy 
Network in West Bloomfield. 
Natalie Rosenfield, director of 
patient care at the network, concurs 

Natalie 

Rosenfield

with Shapiro that it’
s 
important for 
families to have 
ongoing 
conversations about 
what their desires are 
should they be faced 
with a life-or-death 
medical situation.
“My 
recommendation is to have 
that discussion with your loved 
one,” she said, and have many 
conversations about this matter, 
not just one. 
“One of the things we work on is 
helping families to feel empowered 
to make decisions,” she added.
Rabbi Joseph Krakoff serves as 
senior director of the network, 

ELIZABETH KATZ SPECIAL TO THE JEWISH NEWS

When It’s 
Life or 
Death… 

 How do you choose an effective 
surrogate decision maker
in an ICU situation?

health

b
h l
’ d

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