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Assistant professor helping legislature find solution to state’s health care surrogate laws

IU School of Medicine • 2/23/16


INDIANAPOLIS — An assistant professor in the IU School of Health and Rehabilitation Sciences at Indiana University-Purdue University Indianapolis, in conjunction with Indiana Senate legislative partners, has played a key role in the creation of a bill seeking to improve Indiana’s laws regarding healthcare surrogate decision-making. 

Amber Comer, a faculty member in the Department of Health Sciences, provided research used in drafting Senate Bill 193, Consent to Health Care, which was introduced in the Indiana General Assembly. While the bill did not advance through the legislature, it has been earmarked for additional review over the summer session.

Senate Bill 193 would establish an order of priority for authorized consent for another individual, including someone who has served as a caretaker for that individual. It is anticipated that this law would alleviate delays in patient care and minimize the need for court intervention. It is hoped that after review over the summer, it will be reintroduced in the legislature next year.

Healthcare surrogate decision-makers are a crucial part of patient care once a person is unable to make their own medical decisions, usually due to an injury or disease, Comer said. However, recent studies have shown that very few people have completed health care representation forms that legally designate a decision-making surrogate, creating a dilemma for the health care team. 

Comer provided an example: An elderly widow with dementia had been under the care of her adult granddaughter for several years and has been admitted to the hospital for pneumonia. To determine her future treatment plan, her physicians wanted to perform a bronchoscopy, a procedure that requires informed consent. But the granddaughter, who had never been legally named the healthcare surrogate, could not provide the needed consent. This resulted in delayed treatment and placed physicians in the difficult position of determining the legal decision-maker.

“It is important to amend the Indiana Health Care Consent Statute so that it represents real Indiana families,” Comer said. “It is unacceptable for families who are already in crisis because their loved one is sick to have to face the additional burden of being told that they are not allowed to make medical decisions for their loved one without going to court to procure a legal guardianship.”

Unfortunately, without this type of agreement in place, surrogates are generally determined through an inconsistent and out-of-date state law, Comer said. This often creates situations in which patients have no qualified surrogate or have multiple surrogates with competing interests who are unable to reach a consensus on medical care.

Also under current state law, long-term unmarried partners cannot be legally designated as healthcare surrogates. Despite the fact that in most cases these partners had been caretakers or knew the most about their partner’s health, they would be overlooked by state law as a decision-maker, Comer said.

Comer has investigated this issue for several years and was a key player in the creation of this bill. She has received support from the medical community and has given numerous talks on the importance of this bill over the past two years. Comer also plans to speak on this topic at the upcoming Fairbanks Ethics Lecture Series held in March and will be giving a talk to the Indianapolis community as part of the “Before I Die Festival” in April.

Dr. Brent Arnold, professor and chair of the Department of Health Sciences, observed that “this is an excellent example of how the work of Indiana University’s faculty is used to serve Hoosiers. In this case, it will help Hoosier families make more timely medical decisions for their loved ones.”