Do you watch The Pitt?
Spoiler alert! Do you watch The Pitt on HBO? If you don’t, you may want to go watch that first before reading this article. I’m not a big “medical drama” TV show fan, but this one has lived up to the hype, in my opinion. The Pitt tracks the relentless, mile-a-minute madness of a Pittsburgh emergency room.
While the show takes place in Pennsylvania, a journey of a storyline spanning Season 1, Episodes 2 through 4 serves as the ultimate cautionary tale for medical decision-making. It perfectly illustrates a question I get from well-meaning parents all the time: “Can I just name both of my kids as co-agents on my Health Care Proxy so nobody gets their feelings hurt?”
My answer is always a gentle, but incredibly firm, no. In Massachusetts, you can legally only designate one primary Health Care Agent at a time. And honestly? Watching the total meltdown of the Spencer family in The Pitt shows exactly why our state lawmakers got this right. Also, remember Terri Schiavo? That was a hot mess that could have been avoided with a proper Health Care Proxy in place.
But for entertainment value, let’s dive into The Pitt drama to see why trying to force a committee decision in a medical crisis is a recipe for disaster.
In Episode 2, an elderly man named Mr. Spencer is rushed into the ER. He has advanced Alzheimer’s, severe pneumonia, and sepsis. He also has an advance directive saying he does not want invasive, life-prolonging measures. Sounds clear-cut, right? Enter his adult children, Helen and Jereme, who immediately turn the hospital hallway into a legal battleground.
Helen is gripped by pure denial and guilt. She completely ignores her dad’s written wishes and demands that the doctors intubate him and “do everything.” Jereme is totally torn. He knows what their father actually wanted, but he is completely steamrolled by his sister’s aggressive energy. To keep the peace, he reluctantly nods along.
Because they are fighting, the medical staff is caught in a horrific crossfire. Dr. Robby wants to honor Mr. Spencer’s actual wishes, but Helen threatens a massive lawsuit. By Episode 4, the tragic consequences of this sibling gridlock settle in: a suffering patient is subjected to painful, invasive procedures he explicitly never wanted, all because his kids are treating a medical emergency like a dysfunctional family meeting.
If the Spencer family had been at a hospital in Boston or Newton instead of Pittsburgh, Massachusetts law would have stepped in like a strict referee. Under Massachusetts General Laws Chapter 201D, a Health Care Proxy is a legal document where you appoint a Health Care Agent to make medical decisions for you if a doctor determines you cannot speak for yourself. The Golden Rule of Massachusetts Health Care Proxies is that you can only designate one primary agent to make decisions at any given moment.
You can, and absolutely should, name backup agents (e.g., “I appoint my son Jereme. If he is unable or unwilling to serve, I appoint my daughter Helen”). But you cannot legally name them as “co-agents” who must hold hands and agree on everything.
This law is designed specifically to prevent the exact reality TV-style drama we see in The Pitt. In a fast-moving medical emergency, doctors do not have time to wait for a sibling committee to hold a vote, nor do they have the luxury of mediating family therapy sessions by the vending machines. They need one clear, legally authorized “captain of the ship” to give the thumbs up or thumbs down.
However, one of the brilliant aspects of The Pitt is the humanness to these situations. The brother Jereme knew what should be done, but also understood his sister’s agony of letting go of her father. Dr. Robby also saw that some medical decisions are not black and white and that family members sometimes need time to process what is happening in order to make sound decisions. He offered them four simple phrases to say to help them move on with their grief.
So no, you can’t have both of your kids as co-Health Care Agents, but you can have conversations with them now while you are of sound mind so that they understand your wishes and it’s not a surprise in an emergency room. I always encourage my clients to have conversations with their family about their medical wishes and about their estate plan so that everyone is on the same page. Legal documents are always necessary, but they aren’t magical. They don’t take the place of human dialogue and communication.
The main thing to factor in when choosing a Health Care Proxy is whose personality is best equipped to make a tough medical decision, and who will most likely follow your wishes.
Furthermore, I always recommend that my clients speak to their doctor about a MOLST. This is a medical order for life sustaining treatment. This is something you and your doctor sign that goes through various artificial ways to keep a person alive. This was also brought up in the episode too.
Watching Dr. Robby struggle to navigate the Spencer family’s toxic dynamic in The Pitt is a great reminder that estate planning isn’t actually about you, it’s a final gift to the people you love.
By choosing just one primary Health Care Proxy agent, you aren’t playing favorites or saying you love one child more than the other. You are giving them the ultimate gift: clarity. You are making sure that if you ever find yourself in a real-life TV medical drama, there will be no shouting matches, no guilt trips, and no hesitation—just one clear voice making sure you get the exact care you wanted.
Until Next Time,
Julie