Legislative Solutions for Unrepresented Isolated Patients

I enjoying discussing the challenges of healthcare decision making for incapacitated patients without surrogates at UCLA last week.  While the ongoing CANHR litigation has created some uncertainty and concern in California, it at least highlights an under-appreciated issue.

Several states, like Montana and Colorado, have recently enacted legislative mechanisms for making healthcare decisions for unrepresented isolated patients. A bill is pending in New Jersey.

But the challenge of making decisions for incapacitated patients without surrogates is a big problem in EVERY state. One reason that there are so few bills across the country is that hospitals and LTC are reluctant to admit how bad the problem really is.

They are muddling through right now. They have implemented ad hoc solutions. Therefore, these facilities are interested in demonstrating that they are treating their patients fairly and safely. But to the extent that they paint a rosy picture and deny risks, then they also underline the urgency of enacting a legislative solution. 

I am concerned that we get ourselves into a bind. Facilities must make treatment decisions this month, this week, this afternoon. They are naturally reluctant to admit problems with the ways in which these decisions are made. Yet, without identified problems, will there ever be a more comprehensive solution?  If things are working as is, then why do we need to fix it?