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The Health Care Proxy Quiz

Article submitted by Rebecca Sharp Colmer, Me & My Caregivers – 800-530-9129
www.MeAndMyCaregivers.com

Take the following quiz and then ask your family members, doctor, and health care proxy (agent) to take it. They should answer the questions in the way they think you would answer. How well do they know your health care wishes? If your answers are not the same this is a clue that you should communicate your preferences more clearly. You can use the quiz to help start the discussion.

1. If you had Alzheimer's disease and it had progressed to the point where you could not recognize or communicate with your loved-ones and spoon-feeding was no longer possible, would you want to be fed by a tube in your stomach?

a.    Yes
b.    No
c.    Uncertain

2. Imagine that you are now seriously ill and doctors are recommending chemotherapy that usually has severe side effects such as pain, nausea, vomiting, tiredness and weakness that could last for several months. Would you be willing to endure the side effects if the chance of regaining your current health was less than 5 percent?

a.    Yes
b.    No
c.    Uncertain

3. In the same situation as above, suppose that your condition is clearly terminal, but the chemotherapy might give you an additional six months of life. Would you want the chemotherapy even though it has severe side effects?

a.    Yes
b.    No
c.    Uncertain

4. Which of the following do you fear most near the end of life?

a.    Being in pain
b.    Losing the ability to think
c.    Being a financial burden on loved-ones

5. If you were terminally ill with a condition that caused much pain, would you want to be sedated, even to the point of unconsciousness, if it were necessary to control the pain?

a.    Yes
b.    No
c.    Uncertain

6. Imagine that you have moderate dementia causing mental confusion. Almost half of the time you recognize and interact with friends and family on a simple level. In addition, you also have circulatory problems which resulted in one leg being amputated because it developed gangrene. Now the other leg has gangrene and the doctor recommends amputation because the condition could be fatal. Would you want the operation?

a.    Yes
b.    No
c.    Uncertain

7. Is it more important for you to: (a) have your specific treatment preferences followed at the end of life even if family members or friends disagree or (b) have family and friends all in agreement and comfortable with whatever decision is made?

a.    Have specific preferences followed, even if there is disagreement
b.    Have family and friends all in agreement
c.    Uncertain

8. Imagine that you are physically frail and you need help with most daily living activities (dressing, bathing, eating, toileting) and you live in a nursing home. However, your mind is fairly clear most of the time. You have had pneumonia or other lung infections 4-5 times in the past year and each time you had to be hospitalized for several days and given IV antibiotics. The next time you get pneumonia do you want aggressive antibiotic treatment again or just comfort care until death occurs?

a.    Antibiotic treatment
b.    Comfort care only
c.    Uncertain

9. Imagine that you are in a permanent coma and you are dependent on a tube inserted into your stomach for nutrition and hydration, for food and water. Would it be more important to you that decisions about your treatment be guided by particular religious beliefs or spiritual values you hold?

a.    Yes
b.    No
c.    Uncertain

10. If your heart, kidneys, pancreas, lungs, liver could all be used in transplant operations to save lives, would you want to donate them at death?

a.    Yes
b.    No
c.    Uncertain

Remember that planning for health care never stops. Circumstances change, lives change, and our values and priorities may even change. It's a good idea to review your advance directives each year or:

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