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What Rubenfeld was referring to was the onus on patients to be prepared (by way of advance directives, proxies etc.) in order to assist medical staff in the allocation of precious hospital resources. At the worst moments in the pandemic, ICU staff have had to triage patients. Who gets prompt treatment? The young or the old? In many countries during COVID, the demand for life support exceeded supply. Having your plans spelt out and your representatives in place is not only a smart thing to do, it could even be argued to be an ethical obligation in this time of great need.
But there is another incentive to getting one’s house in order. There is a significant number of media reports that report a possible shift in medical treatment based on the notions of informed ‘consent’ to informed ‘assent’. (The notion of ‘informed assent’ is alluded to our discussion of physician or medical life -sustaining treatment orders).
Informed assent refers to a situation where the medical staff assume blanket responsibility for end-of-life care decision- making. Rather than the permission to turn-off a ventilator being sought from the patient’s agent, where informed assent is practised the medical professional has been hitherto empowered