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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