QUALITY IMPROVEMENT


Designating a Healthcare Proxy: It’s Never Too Soon to Have ‘The Conversation’


By Cynthia Helzel W


hen Pulitzer Prize-winning journalist Ellen Goodman found herself in the position of having


to make decisions about her mother’s end-of- life care, she was distressed to realize that she had no idea what kind of care her mother would want. The experience led Goodman to co-found The Conversation Project, a non- profit dedicated to helping people define their end-of-life wishes and ensure that those wishes are respected. Goodman cur- rently serves as director of the organization. “Half of all people over 65 who go into


the hospital are unable to make decisions for themselves,” Goodman says. For this reason, every adult over age 18 needs a healthcare proxy. A proxy is the person designated to speak for the patient and make sure his or her wishes are known and respected. Without a designated proxy, patients who can’t express their needs may not get the kind of care they desire, or may end up with invasive or aggressive treatments they do not want. When choosing a person to serve as a


healthcare proxy, it’s important to find someone with enough backbone to stand up for the patient’s wishes whether or not they agree with every aspect of them. “You need someone you can talk to, who will re- spect your wishes, who will stand up for you, and who will talk to the rest of the family so there isn’t a crisis between the children,” Goodman says. She recommends thinking through the designation carefully rather than automatically choosing a spouse or adult child. Similarly, there are things people need to


think about if they are asked to be a health- care proxy for someone else. The proxy has to be able to make quick decisions, must be pres- ent in the medical facility when needed, and


40 SENI LIVIN EECTIVE / ISSUE 3 2017


needs to be comfortable with the responsibility to uphold the patient’s directives. The proxy must also take time to thoroughly discuss and understand the designator’s wishes before a medical crisis happens. Goodman suggests several ways to get


the conversation started whether a person wants to choose a proxy or would like to encourage someone else to do so. “An adult child can say, ‘Mom, I need your help. I may come to a time when I have to make decisions for you, and I want to be sure that I do the right thing,’” Goodman says. Other ideas include completing the Project’s Conversation Starter Kit and sharing it with another person or mentioning a past situa- tion in which a person was extremely ill and the family did not know what kind of care the patient would want. “People are reluctant to have these con-


versations, but they almost always find that they are intimate and caring conversations, and are reassuring,” Goodman says. She advises people to talk things over more than once to make sure everything is thoroughly understood. Senior living communities can help spread the word by offering presentations


about the importance of naming a health- care proxy and handing out The Conversa- tion Project’s user-friendly kits to residents, family members, and staff. The kits are available in several languages


and include the “Conversation Starter Kit,” “How to Choose a Healthcare Proxy & How to Be a Healthcare Proxy” and “How to Talk to Your Doctor” as well as special- ized kits for loved ones of people with de- mentia and parents of seriously ill children. They are produced in collaboration with the Institute for Healthcare Improvement. The kits can be printed free from the organi- zation’s website at theconversationproject. org/starter-kits/. Large quantities are also available in printed form. “People always say it’s too soon. But it’s


always ‘too soon’ until it’s too late,” Good- man says.


Contact The Conversation Project  


conversationproectiiorg teconversationproectorg


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