Bioethics Blogs

Friendless & Voiceless in Massachusetts

Secure in his chair on a Boston critical care ward, the middle-aged man was getting his hair cut. This meant nothing to him. To the best of a doctor’s ability to know such a thing, there was no meaning-making left for the man, since the heart attack that had rendered him “probably permanently unconscious.”

And yet the haircut meant something to the hospital staffer who provided it. Indeed, it meant everything. In particular, it meant someone in the worst of circumstances and alone in the world could find care at this hospital. Not just treatment, but care. And that’s good for morale.

What is not good for morale is continuing treatment that — again, to the best of a doctor’s ability to know such a thing — does a patient no good, and may do harm. For this patient, that transition loomed.

The man strapped into the chair, unable to sit upright on his own, is an immigrant from the Far East with no apparent family in this country. He has no insurance and little money. He clearly did not anticipate a catastrophic heart attack, and so put nothing in writing about his wishes for medical care. Neither had he designated someone to speak for him in such an event.

He is what is known as an unrepresented patient, or a patient without a surrogate decision-maker. Both terms sound coldly clinical and lawyerly to me. Neither sounds especially human.

I prefer another term sometimes used: unbefriended. This term strikes some colleagues on the Harvard Community Ethics Committee as overly judgmental, as though the patient were unworthy of friends.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.