Informed assent refers to a situation where the treating medical staff are provided with blanket responsibility for end-of-life decision-making on your behalf. Rather than seeking permission from your agent at each turn, informed assent empowers the medical professional prior to the emergency moment with the responsibility for the decisions that might need be made.
In an article in the 27 March 2020 edition of the Journal of the American Medical Association (JAMA), the point was made that informed assent may be beneficial as it allows a person’s family to agree with the medical advice on offer: remembering that the doctors will be weighing up any number of factors, including who could benefit most from the precious use of the ventilator. And it takes into account the likely fact that the family will not be present at the time the decisions need to be made.
While some media reports have suggested that this is euthanasia by stealth, the cold hard facts are that limited health resources are now being prioritised in ways that were previously unimaginable. Furthermore, COVID can lead to rapid declines in one’s health status. For older people and those with the much- reported and often-clichéd ‘underlying conditions’, COVID raises profound and confronting questions. While an advance directive and health proxy may be useful for those who want to take their chances with a hospital admission, for others the onset of COVID might signal something else: perhaps now is the time to go?
For those who reject the idea of a COVID hospital admission, the new COVID chapter in the Handbook makes essential reading.