Why does a doctor want a patient to identify a friend before a major procedure? (if this is still being wanted by doctors)

Question

If a patient is going to have a procedure done by a doctor, like for diagnosis or treatment, maybe surgery, a doctor might ask the patient for a patient's friend's contact information. At least, they used to. The friend didn't have to agree or be present. Is there any legal reason for the request? I think the doctors don't usually state a reason for the request, but I think they'd refuse to go ahead with the procedure unless given that information. (I don't think this applied to emergencies or mandatory procedures such as with deadly contagion, but most procedures were not under those exceptions.) Besides why, what happens if the patient doesn't disclose or doesn't have a friend?

Answer 1

The doctor wants an emergency contact who can be reached to assist in figuring out how to make medical decisions for the patient if medical decisions have to be made (e.g. termination of life support) and the patient is incapable of communicating those decisions.

Ideally, the doctor would like to have someone who has a medical power of attorney (or some other instrument appointing a medical decision maker for the patient) to make medical decisions for the patient in those circumstances.

But if there is no medical power of attorney in place, which sometimes isn't feasible because major medical procedures can been needed on quite short notice, a friend is the next best thing. The doctors (or more realistically, their lawyers or hospital administrators working with them) need to be able to locate people who have the authority to make those decisions as a matter of law in the absence of a medical power of attorney. As a fresh out of law school attorney at my first law firm job, in a firm that represented a hospital, this was my job.

This is much easier to do if there is a friend of the patient around who knows the patient, who can assist in figuring out who the patient's next of kin and close friends are (as they are usually the default medical decision makers), where the patient is domiciled (which influences which state or country's law applies to some key issues, and which court requests for court action have to be filed in), and similar issues.

A friend might, for example, know that the patient is usually known by their nickname, rather than the legal name that appears on the patient's ID, which might be helpful for a variety of reasons (I know multiple people who usually go by a name that is completely different than the legal first name that appears on their ID, and this is true of many famous people as well).

Also, the friend designation generally includes in the fine print, a limited HIPAA waiver, allowing doctors to discuss matters with someone connected to the patient which would often not be allowed otherwise, and the friend would not usually, in turn, be bound by HIPAA limitations since the friend isn't someone required to keep HIPAA secrets the way that the medical personnel and insurance company officials must, so the friend can inform others for whom there is no HIPAA waiver but have a limited need to know.

For example, a doctor or hospital administrator is in a poor position, due to HIPAA, to tell a pet sitter that they'll need to take care of the patient's pet for another half day or day due to minor complications in the procedure that need to be monitored on an in patient basis since this implicitly discloses information subject to HIPAA to someone for whom there is no waiver, but a friend can do that and by being designated can receive HIPAA protected information.

A friend may also be familiar with the patient's employment situation if the health insurance information given wasn't accurate or there is a potential worker's compensation coverage, and may be aware of general information about the patient that could help diagnose a puzzling examination results at a time when the patient can't communicate (e.g., has the patient travelled abroad recently).

More mundanely, a friend can help notify an employer of the patient that the patient may not be able to return to work as soon as the patient had anticipated, is likely to know if arrangements have to be made for the patient's pets (if any) if discharge is delayed, may be able to arrange a ride home from the medical facility if the patient is unexpectedly unable to do so alone, may be able to arrange to get clothes to the medical facility if the patient forgot to bring them (perhaps bringing a roommates clothes that don't fit instead of their own), and can help the patient to remember discharge instructions if the doctors fear that the patient will have trouble adhering to or remembering them (e.g., some anesthetics, such as fentanyl, impair short term memory for a time period that can extend for a few hours after the patient wakes up so the friend can go over that with the patient a few hours later in some cases).

Doctors aren't legally prohibited from proceeding with medical treatment or a major medical procedure just because the patient can't identify a friend, and in an ER situation, this information is often impossible to obtain. If the patient genuinely doesn't have any friends or family or employers (e.g. a self-employed remote worker), which happens even though it is rare, it is unlikely that a procedure would not go forward as a result.

But, because having this information can make many otherwise difficult to solve problems much easier to resolve, it is standard procedure for medical facilities to ask for this information.

Answer 2

france

A general principle of medical ethics (codified in article L1111-4 of the public health code) is that the patient should take all decisions concerning their own health, in particular whether to undergo certain medical procedures.

When the patient is unable to provide informed consent (i.e.: understand the information communicated by medical professionals, think over it, make a decision and communicate it), this principle cannot be directly applied. It then becomes "make the best guess of what the patient would have wanted". There are some cases where it is impossible to make such a determination because of time constraints (e.g. an unidentified car crash victim comes through ER), but in many cases it is possible.

Enter article L1111-6 of the public health code:

Toute personne majeure peut désigner une personne de confiance qui peut être un parent, un proche ou le médecin traitant et qui sera consultée au cas où elle-même serait hors d'état d'exprimer sa volonté et de recevoir l'information nécessaire à cette fin. La personne de confiance rend compte de la volonté de la personne. Son témoignage prévaut sur tout autre témoignage.

Any patient aged 18 or above may designate a trusted person who might be a relative, a close friend or their general practitioner. That person will be consulted in case the patient is unable to express their will and receive the necessary information. The trusted person testifies about the patient's will. Their witness statement prevails over any other witness statement [as to the patient's will].

Anecdotically, from a chat with an oncology practitioner 5-ish years ago:

• a large fraction of patients do not spontaneously discuss such matters with family, except in very general terms, before they lose the mental capacity to take decisions (hence, medical practitioners will push them to do so)
• in the vast majority of cases, families accept the general principle (once it is explained to them), and do not try to impose their own preferences over their estimation of the patient's will.
• cases that reach the media are extremely rare and highly unusual. "Ultra-religious member of the family claims the patient would have objected to any measure that could be construed as suicide under that religion's interpretation, non-religious spouse says otherwise" is rare. "The patient did not discuss their wish about organ donation if they die" is very common.