The unconscious man in his 90s was brought to the emergency room where Dr. Douglas White did intensive care. The team could not find relatives to make medical decisions on your behalf.
"He outlived all the family. We could not find friends. We even ask the police knocked on the neighbors," said White, who now heads an ethics program at the Medical Center of the University of Pittsburgh.
Also, there were no instructions. In the end, the hospital's ethics committee had to help the medical team decide if kept him connected to devices.
Experts describe gender of patients as "friendless". However, it can also look like this, although it has friends and family, if you are incapacitated and has not designated anyone as a reliable proxy for health issues.
Hardly say that Elizabeth Evans is unable to make a decision now - or has no friends. Voluntary tarimbada, enjoys reading, gardening and can drive for five minutes to the supermarket. With nearly 89 years and using a walker, she still lives on his farm in Pittsburgh. Slowly, Elizabeth is recovering from the death of her husband, Jerome, last year.
The trauma left her with clear convictions how their decisions to the end of life. "After seeing my husband connected appliances with everything they do, I do not want it for me," she said.
But if Elizabeth can not express their will during a health crisis, who will speak on your behalf? The couple had no children. The brother, who lives an hour away, is 97; the youngest sister reside in Virginia. The nearest group of local friends, two died.
"I'm not the kind of person who cares about something before it happens," she said. Thus, while the doctor has given a form with instructions for completion, she did not. Or speak with her sister or friends about your wishes.
During a telephone interview, Elizabeth thought of asking the lawyer or trusted doctors to serve as prosecutors. But in Pennsylvania, as in many US states, the law prevents the medical service provider assume this function.
If she gets disoriented in an emergency room, social workers may have to pursue his relatives. The hospital staff considers friendless person whose family members are not available to make decisions.
Many people already fit this problematic category. Sixteen percent of patients in intensive care units on the west coast of the US fit into this classification, according to 2007 study which White is one of the authors. Another of his studies reported that the ICU patients who died, 5.5 percent had no friends or - ethics experts prefer a more accurate and less stigmatizing term - did not have representatives.
The numbers are expected to increase as the population ages, partly because the dementia rate rises with age. "We have seen a growing pattern: more and more patients with no ability to decide without prosecutors and did not fill the form with instructions," said Martin Smith, director of Clinical Ethics at the Cleveland Clinic.
The types of elderly without representatives may also change. In the past, many were marginalized - homeless, addicts, mentally ill, alienated. The generation of "baby boomers" (1945-1964), with a higher rate of childless couples and divorces, have smaller, mobile families, with longer life cycles. "They may have a very ordinary life and live longer than everyone around him," said White.
Hospitals, government agencies, researchers and policy makers have been dealing with this issue, though not quickly enough, and are creating a series of adjustments. For example, some states are expanding prosecutors authorized by law.
In most of them, statutes specify which relatives can authorize or medical procedures in the case of a patient who has not designated someone to make a decision: first spouses, usually followed by siblings and adult children.
It must be recognized that, of all the destinations that a person without representatives fear, the developments in an ICU may matter much less than the years leading up to that point. In a society that is as true of family caregivers, who will offer help on a daily basis that most seniors may need to have no relatives? This question, tell me readers, keeps them awake at night.
However, with regard to health care, people can recognize that refer to the status of friendless if they have a close relative to represent them. They can take preventive measures, calling more distant friends or relatives as proxies. If you can afford it, people can resort to lawyers, geriatric care managers or professional guardians. Some tested committees made up of professional and reliable partners.
People can explain the beliefs and desires to prosecutors, paid or not, and document your preferences in very detailed guidelines. "They give clues about what the patient really values, some guidance on what circumstances they consider worse than death," White said.
This, Elizabeth Evans decided during our conversation, is your best bet: write instructions and have frank conversations with her sister, and perhaps with the lawyer.
"I think that nothing will happen to us, then we see what can happen. I should have done it yesterday."
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