Across the country, millions of Americans are getting the Covid vaccine. For many, deciding whether to get one is no big deal. (“It’s best for everyone, right?”) For those who are unable to weigh the risks and benefits, someone else has to step in and give consent. That might be a guardian or a health care surrogate, determined by choice or by statute. Deciding what’s best isn’t always easy. It’s one thing to grapple with yourself about whether to get a medical treatment. It’s quite another to make that decision for someone else. Especially someone who is unable to consent and maybe also unable to express their wishes.
The Individual Is What’s Best
Fleming & Curti, as a firm, is a licensed fiduciary, and we serve people who can no longer manage their own affairs as Guardian or surrogate if named agent under health care power of attorney. Being the decider in these circumstances is a serious, sobering endeavor, and we, like many other fiduciaries, approach it carefully. In fact, our license requires us to “exercise extreme care and diligence” when making health-care decisions such as getting a vaccine. As a health-care decision maker for someone else, the answer, even in a pandemic, is never an automatic yes.
Decisions made for those who no longer can act for themselves should always center on the individual, not what we, a caregiver, or a facility, think is best. At least not at first. There’s a very deliberate step-by-step process, one that’s more challenging during a pandemic.
With Covid-protections in place, it has been difficult to have meaningful time with the people we serve while maintaining safety, both ours and theirs. The fiduciaries and social workers on our staff Zoom and FaceTime, visit through windows, and outside, and at a distance with double masks. They talk with caregivers and medical professionals in detail. When we are faced with signing a consent for someone else, we pause and make sure that, if we sign, we’re doing it for the right reasons and employing the appropriate process.
Step one: Do all we can to allow the person to participate, share with them the risks, side-effects, and benefits of getting the shot, and allow them the chance to share their feelings — fears, apprehensions, and, with Covid, hopefulness that life can get back to normal.
Step two: If they are unable to understand or express their preference, then we consider the person’s most recent views and past decisions concerning treatment (such as advance directives and living wills) or vaccines specifically, and also current concerns or fears about the pandemic and whether not getting the vaccine will result in harm. This can involve asking friends, family, caregivers, clergy, and others.
Step three: If such determination is not possible, a decision can be made in the “best interest” of the person. In this case, weigh risks and benefits, consulting with family and medical team about medical history, current condition, and living arrangement.
It’s vital to leave our personal opinions about vaccines out of the process. It’s also vital not to decide based on what others might think is best or demand. Opinions of others, are welcome, of course. In the end, what the person might want or what is best is the deciding factor.
Consider Urgency and Act
This process can take time, and vaccine windows can be short. As a result, considering whether to consent should occur well before the shots arrive at the care facilities. Those trusted with health-care decisions should be proactive. Reach out to medical professionals, don’t wait. Find out whether consent forms will be required as early as possible. Then, when the needles are loaded up with vaccine, the shots can be delivered quickly and efficiently. That’s what’s best for everyone.