GNYHA hosted a program on January 17 on the challenging, increasing problem of “unbefriended” patients, who are those without known surrogates to make health care decisions for them when necessary. In such scenarios, decision-making responsibility may fall on clinicians caring for the patient, an ethics review committee, or a court-appointed guardian, which is a lengthy and often ineffective approach.
The program featured an interdisciplinary group of speakers comprised of ethicists, lawyers, and clinicians who discussed the serious issues that can arise in this multi-faceted area as hospitals seek to ensure that unbefriended patients receive legally compliant and ethically responsible health care treatment.
Nancy Berlinger, a research scholar specializing in ethical issues related to aging, chronic illness, and end-of-life issues, kicked off the program with a discussion on what constitutes an unbefriended patient, types of patients who tend to become unbefriended (such as those with chronic mental illness or a lifelong cognitive disability), and why hospitals need to establish decision-making processes for unbefriended patients.
Deborah Korzenik, senior legal counsel at Mount Sinai Health System, discussed the legal landscape for unbefriended patients. She focused on the New York State Family Health Care Decisions Act, which provides a framework for treating unbefriended patients, including the decision-making processes for vulnerable populations.
Deirdre Newton, a senior legal counsel at NYC Health + Hospitals, outlined social and practical barriers to the safe discharge of these patients, emphasizing that guardianship and injunction proceedings are last-resort remedies.
Adira Hulkower and Barrie Huberman, who serve as ethics consultants for Montefiore Medical Center and Northwell Health Lenox Hill, respectively, presented detailed case studies that illustrate the challenges and strategies of dealing with unbefriended patients.
Terry Altilio, a social worker at Mount Sinai Beth Israel, discussed the resources she uses to conduct a diligent search for surrogates before a patient is determined “to be unbefriended.” Ms. Altilio’s presentation provided a wealth of practical tips. These and other program materials are available on GNYHA’s website.
Due to the growing interest in this important topic, GNYHA will soon announce future programming. Please contact Laura Alfredo or Helen Yan with questions or suggestions.