By Rafael Solorzano
Unbefriended patients. (Patients who lack the capacity to make their own medical decisions but who have no family members or other surrogates to speak on their behalf).
There are several thousand Canadian and American Expats residing in the Peninsula, many of which are seniors and a number of them live alone and don’t have much contact with neighbors when they become sick, incapacitated or die, thus it’s up to neighbors/friends to take action in notifying emergency services, thus, as a consequence of this, authorities are left with few choices to report the death because some of the people did not leave any information nor instructions with friends and/or neighbors to notify a next of kin, the problem is further compounded when the deceased happened to reside in a remote location and the body is to dispose in an unmarked grave unless locals (ex-pats and Mexicans) contribute to the burial.
Unbefriended patients in Mexico frequently are people who are/were socially isolated. Often they fall through societal cracks into a no-man’s-land without traces of their pasts, preferences, and advocates. The majority live by themselves in Mexico and frequently have multiple chronic conditions that will require timely and wrenching decisions on major medical or life-sustaining treatment.
In Mexico, States nor localities have not developed temporary medical legislation nor can they afford to provide treatment guardianship programs. This required that patients appoint a legal guardian. In Baja California a person can appoint more than one legal guardian or courts may appoint surrogates with the limited purpose of making designated healthcare decisions. Given the impending growth of the unbefriended elderly population in Mexico and in the Baja California Peninsula, this merits attention.
Conclusion
The dilemma of finding workable decision-making mechanisms for unbefriended elderly patients is a difficult one. There are few alternatives and no, there is no state nor county-wide community ethics committees. This requires that Judges, attorneys, public guardian staff, public officials, social service providers, members of the community and healthcare professionals join forces, but this is going to take much time.
The predicament faced by those isolated and incapacitated individuals and seniors in Mexico cannot be underestimated. I don’t think there are any studies determining the number of Expat patients who are alone and die; it is sad that patients die in discomfort and alone.
Please take note, let neighbors know who to contact in case of an emergency, keep vital records and important documents in the hands of close friends, prepare a list of the people to contact.
You surely don’t want (your relative or friend) to end up in an unmarked grave and/or to have your home and belongings end up as loot to disreputable people (as it, unfortunately, happens more often than not).
Surrogate decisions:
1. Directed decision making allows a person to specify certain decisions in advance and rely in a person who can be appointed as a legal guardian.
2. Delegated decision making allows a person to delegate authority to an agent through a healthcare power of attorney; the individual maintains autonomy by specifying who will decide about treatment and which factors to take into account in the event of later incapacity.
Surrogate decision-maker: A surrogate decision-maker, also known as a health care proxy or agent, is an advocate for incompetent patients. If a patient is unable to make decisions for themselves about personal care, an agent must make decisions for them, and in Mexico, you can name several persons as legal guardians and grant power of attorney (advance directives), the power of attorney is not exercised conjointly.
The Mazatlan Post
