Alison Stohler

Alisha, thank you for sharing your perspective! Your experience as a public guardian brings a valuable dimension to this discussion, especially when considering difficult family dynamics and the challenges of making decisions on someone else's behalf.

Regarding conflicts of interest, complicated family situations would certainly be a concern for me. I've discussed this with an attorney I work with, and I believe much of the risk can be addressed through careful planning before an urgent situation arises.

Ideally, the client and their attorney have already established legally executed documents, clearly documented healthcare and end-of-life preferences, and discussed how potential disagreements should be handled. Those documents provide the legal framework for guiding decisions when the client can no longer speak for themselves.

Another important consideration is serving as both an independent patient advocate and a professional healthcare surrogate. The Patient Advocate Certification Board addresses the importance of recognizing dual-role conflicts, and I believe separate written agreements, clearly defined responsibilities, and transparent billing are essential.

Other potential conflicts include financial incentives, referral relationships, family members who are paying for services, and situations where our personal beliefs differ from the client's expressed wishes.

That last one is particularly important to me. For example, imagine a client who specifically requests that certain family members not be notified of a serious medical event. Personally, I might struggle with that decision. However, before accepting the responsibility of serving as their healthcare surrogate, I would need to determine whether I could honor those wishes within the boundaries of the law and my designated authority.

I believe recognizing our own personal boundaries is just as important as understanding our professional responsibilities. If we cannot set aside our personal feelings and faithfully represent someone's wishes, we need to recognize that before agreeing to serve.

I would also consult with a trusted attorney before accepting a case involving significant family conflict.

I think these are important conversations for our profession as more advocates consider professional healthcare surrogacy.

Given your experience as a public guardian, I'm curious whether you've encountered situations where your personal beliefs differed from the individual's expressed wishes. How did you navigate those situations while maintaining your professional responsibilities?

I'd love to hear your perspective, along with any additional safeguards or conflicts you think we should be considering. I believe we can all learn from one another's experiences.

Thank you again for contributing to this discussion!

These are great questions, Alison, and I look forward to input from others. In my previous role as a public guardian (appointed by the probate court in my state), I had very clear guidelines on decision-making, and while the healthcare proxy/surrogate role is slightly different, I feel the decision-making process is much the same. Where I do have some questions is on the question of how I would respond if there were a family member contesting my decisions. In my guardian role, I always educated and encouraged family members to take their concerns to the probate court, where the judge would issue a ruling on the legal appropriateness of my decision-making.

Can you give any examples of concerns about conflict of interest?

In a surrogacy situation, the court likely still has some ability to hear concerns and issue findings. Which court? That probably varies from state to state. Developing or obtaining a document that potential surrogacy clients complete AND review with both you and any involved (or potentially involved) family members is key. Reviewing that document after any significant health changes and with some regularity is essential.

I plan to consult with my attorney on this before moving forward with accepting any surrogacy cases in which there is the possibility of family dispute. Heck — even the most basic families disagree over these kinds of issues. I might only accept surrogacy clients who are truly solo agers!

Thanks for opening this conversation!

Hi Alison,
Welcome to this wonderful advocacy community!!.. I am Sangeeta Buragohain, an Independent Patient Advocate, Physical Therapist / Insurance reviewer by background and a part time advocacy liaison at Greater National Advocates. I specialize in hospital and rehab advocacy.

HI alison! welcome and thanks for introducing yourself!

There's a huge thread of introductions. I'd like to encourage you to add your info there and interact with others in that conversation!

gnanow.org/community/taking-business-to-next-level/general-tbnl/91-welcome-to-pa360-please-introduce-yourselves.html

Hi Alison! Nice to meet you! I am Sofie, and I work at Greater National Advocates as a manager. I don't practice advocacy directly, but I work hard to make sure our advocates get what they need and keep GNA running smoothly!