Choosing the Right Healthcare Agent: Lessons from The Pitt

I recently started watching The Pitt, a new medical drama that delves into the tough medical decisions families and healthcare professionals have to make. The second episode of the series had a storyline that underscored the importance of choosing the right healthcare agent, and the potential complications that can arise when you appoint co-agents with differing viewpoints.

Mr. Spencer, an elderly man with Alzheimer’s disease, arrives at the hospital with pneumonia and sepsis. He had an advance directive explicitly stating that he did not want to be intubated or resuscitated.

He named his children, Helen and Jeremy, as co-agents under his healthcare power of attorney. Jeremy wanted to honor his father’s healthcare wishes, but Helen says she is not ready to let her father go.  Jeremy defers to his sister who insists on intubation. This decision directly contradicts her father’s documented wishes.

Understanding Advance Directives and Medical Powers of Attorney

An Advance Directive or Living Will is legal document that allows individuals to outline their preferences for medical treatment in situations where they can no longer communicate their decisions. This often includes directives about life-sustaining treatments such as mechanical ventilation or resuscitation.

In contrast, a Medical Power of Attorney designates an agent to make healthcare decisions on behalf of the principal (the person creating the document) when they lack capacity. The agent is expected to honor the principal’s wishes and best interests.

While both documents serve to guide medical care, conflicts can arise, especially if the decisions of your healthcare agent conflict with the stipulations in the advance directive.

Legal Considerations in Texas and North Carolina

Texas:

Texas law recognizes both advance directives and medical powers of attorney. According to the Texas Health and Safety Code, if a treatment decision or an advance directive conflicts with another, the most recent document takes precedence. This means that if an agent under a medical power of attorney makes a decision that conflicts with an earlier advance directive, the agent’s decision may override the directive. This can lead to ethical and legal challenges, particularly if the agent’s choices appear to contradict the principal’s known wishes.

North Carolina:

In North Carolina, individuals can specify whether their advance directive or their healthcare agent’s decisions take precedence in case of a conflict. This flexibility provides clear guidance to healthcare providers and agents, ensuring they honor the individual’s preferences as intended

Risks of Appointing Co-Agents

Designating multiple individuals as co-agents can lead to disputes, as illustrated in The Pitt. Conflicting opinions among co-agents can delay critical medical decisions and may result in actions that contradict the principal’s documented wishes. Such disagreements can also place additional emotional strain on family members during already challenging times.

Best Practices for Choosing Healthcare Agents

• Select a Single Agent: To minimize potential conflicts, appoint one trusted individual as your healthcare agent.
• Communicate Your Wishes Clearly: Discuss your medical preferences in detail with your agent. This ensures they understand and are willing to honor your decisions.
• Document Preferences Thoroughly: Clearly outline your medical treatment preferences in your advance directive to guide your agent and healthcare providers.
• Review and Update Documents Regularly: Periodically reassess your advance directive and medical power of attorney. Your preferences may change over the years. Updating your documents regularly ensures your documents reflect your current wishes and that your chosen agent remains willing and able to act on your behalf.

TThe complexities highlighted in The Pitt serve as a reminder of the importance carefully considering who should serve as your agent. By thoughtfully choosing the right healthcare agent and clearly documenting your medical preferences, you can help ensure your wishes are respected, even in challenging circumstances.