Making decisions for your spouses health care

In their marriage vows, husbands and wives promise to stay together "in sickness and in health."

But that doesn't mean they necessarily want each other to make medical decisions for them if their health fails.

A survey has found that one-third of married people would pick someone other than their spouse to make medical decisions if they were unconscious or too sick to decide for themselves.
"This was an unexpected finding," said Dr. K. Michael Lipkin of the Northwestern University Medical School, who published the survey in the Journal of General Internal Medicine.

Lipkin surveyed 299 adults. Of the 133 who were married, 27 said they wanted a child to make health care decisions for them, 7 wanted a sibling, 4 wanted a parent and 6 wanted someone else. Of those who wanted a child to be their surrogate, 20 would pick a daughter and 7 a son.
Lipkin suggested several possible reasons why so many married people wouldn't pick their spouses. Some might not want to place such an emotional burden on a spouse, especially an elderly one. Or they might feel that another person had more medical expertise. And in some cultures, spouses continue to defer to their parents, even after marriage.

Federal law requires hospitals and nursing homes to ask patients whether they have an advance directive, such as a living will or health care power of attorney.
However, advance directives require witnessing or notarizing and might not apply to common medical situations. The documents are "infrequently used and seldom effective," according to a 2004 article in the Archives of Internal Medicine.

Most willing to name proxy

Rather than relying on advance directives, doctors instead should simply ask patients to identify a proxy to make health care decisions, Lipkin said.
The main purpose of his study was to determine how willing patients were to do this. He found that all but one of the 299 patients were willing to name a proxy. And 91 percent said routinely asking patients to name a proxy was a good idea.

The survey was conducted at a general eye clinic at the University of Chicago, where Lipkin formerly worked.

Although respondents had different ages and states of health, they did not necessarily represent the general medical population, Lipkin wrote.