This question stems from an actual event (but I will try to keep it general), but the situation is now over, so I hope that this thread will not be closed. If a patient with a health care proxy refuses to give consent for something, and the doctor later decides that the patient does not understand the situation, can s/he attempt to get consent from the appointed health care agent? If the health care agent also refuses to give consent, can the doctor later attempt to get approval from any alternate health care agents?
To sum it all up: How many tries does the doctor get, and would one “yes/no” invalidate all the past “yes/no’s”?
Is the patient an adult who is awake and mentally competent? If the doctor thinks they didn’t understand the situation, they need to be explaining to the patient again until the patient does clearly understand. Language barriers have to be addressed, if that’s the source of the problem. The doctor doesn’t get to keep fishing for someone to agree with them.
I have a copy of my NYS Health Care Proxy form in front of me. It says (my bolding):
Further down there is an optional section:
Bottom line, AFAIK, if the doctor doesn’t agree with the patient’s wishes, it’s too bad for the doctor. And frankly, I wouldn’t want a doctor - or anyone - to be in the position of going over my head and forcing treatment (or lack thereof) that I didn’t want.
New York Health Care Proxies are governed by Article 29-C of the Public Health Law. The proxy should not come into effect until there is a physician makes a determination that the principal lacks capacity to make health care decisions under section 2983, which provides in part:
Determination of lack of capacity to make health care decisions for the purpose of empowering agent. 1. Determination by attending physician. (a) A determination that a principal lacks capacity to make health care decisions shall be made by the attending physician to a reasonable degree of medical certainty. The determination shall be made in writing and shall contain such attending physicians opinion regarding the cause and nature of the principals incapacity as well as its extent and probable duration. The determination shall be included in the patient`s medical record.
The doctor mentioned that the patient didn’t appear to be mentally competent just before asking the first health care agent’s permission. I’m not sure if that was placed in the records though, and the doctor allowed the patient to make other decisions after making the comment about competency.