Who gets to make my medical decisions? (Part 1)
I previously worked in medical social work for about 5 years, mostly in hospital settings. Something that people often have questions about is “Who gets to make medical decisions?” The short answer is that as long as you’re of age to make medical decisions about your care and you’re considered competent to make decisions, YOU are the one who makes decisions. The longer answer is that, sometimes, it’s more complicated than that.
Let’s start with the idea of “you’re of age to make medical decisions.” I’m focusing on Texas, because that’s where I’ve worked in medical settings and primarily where I practice. If the person in question is elsewhere, the rules may be different. I’m providing a shortened explanation, but the full information about minors in Texas can be found HERE. If you’re over 18, you aren’t a minor and can make your medical decisions. If you’re under 18, however, the answer will depend on the circumstances. “Under Texas law, a patient is considered a “minor” if he or she is younger than 18, has never been married, and has not been legally declared an emancipated minor.” In Texas, a minor can consent to treatment if the minor is:
On active duty with armed services.
16 years old or older and residing apart from parents, managing conservator or guardian and managing his or her own financial affairs.
Unmarried and pregnant and consenting to treatment related to pregnancy other than abortion.
Unmarried and the parent of a child and has actual custody of that child and consents for treatment of the child.
Consenting to diagnosis or treatment of an infectious, contagious, or communicable disease that is reportable to the Texas Department of State Health Services.
Consenting to examination or treatment for chemical addiction, dependency, or any other condition directly related to chemical use.
Consenting for counseling for suicide prevention, chemical addiction or dependency, or for sexual, physical, or emotional abuse.
The next issue, competency, can be a thorny question, but really comes down to a few things. A great list of questions to determine competency comes from the National Institute of Health:
Does the patient understand the current medical condition?
Does the patient understand the natural course of the current medical condition?
Does the patient understand the proposed treatment intervention?
Does the patient understand the risks and potential benefits of the proposed treatment and/or intervention?
Does the patient understand what is likely to happen if the proposed treatment intervention is refused?
Does the patient understand whether there are any viable alternatives to the proposed treatment intervention?
Does the patient understand the potential risks and benefits of the alternative treatments?
Some of the common situations I saw where a patient was considered not competent included:
Patients with advanced dementia, Alzheimer’s Disease, or confusion
Patients under the influence of medications/substances
Patients experiencing intense pain or withdrawal symptoms
Patients with intellectual disabilities
I suppose the logical next question is, “Ok, if I can’t make decisions, who does make decisions for me?” I’ll answer that in the next part.
