Consent, Conflict and Decision-Makers
For a patient to give consent for a treatment, intervention or procedure, he or she has to: understand what it is and understand what it means.
For example: 96-year old Helen completely understands that she’s going to have a procedure for glaucoma, but when asked to explain what that means to her, and expectations for recovery, she turns to her daughter and says, ‘You explain.’ In this case, she’s not competent to give her consent because she’s lost what’s described as ‘executive functions’. From WebMD
Executive functions work together to help a person achieve goals. Executive functions include the ability to:
- manage time and attention
- switch focus
- plan and organize
- remember details
- curb inappropriate speech or behavior
- integrate past experience with present action
The consent issue complicates End of life decisions that are already a mine-field of conflicts – amongst siblings and or family members, and often with health care professionals. In each case the reasons are the same:
- Decisions based on what feels best for the decision-maker – not what’s best for the patient
- Not ready to ‘let the patient go’
Live in memory, Live in love
This is Sam, my father-in-law. He's going into his 103 year, and is still smiling. Yet every night, his last words before falling asleep: God, please let me die He's not suffering in any major way: the swollen ankles and chronically congested chest don't bother him...
Medical Aid in Dying: I signed up to be a witness
I was nervous about this new role I’d signed up for: volunteering to be one of two witnesses to make official a patient’s request for medical assistance in dying.This involves witnessing the paperwork necessary for a MAID (Medical Aid in Dying) request. The...
My big brother, John, had the best possible end
My bro died at home, on Palliative/Hospice Care Although we did not know it at the time, my brother's 'end' started November 2018, with a brain tumour diagnosis. Surgery before Christmas that year was deemed 'successful' and John was in such good physical shape that...
Men writing about The End of Life
Men writing from the inside out about life’s end. In the picture in The New Yorker, sitting with his dog, on a bench by a park, Roger Agnell, looks none of his 93 years. Famous for his sports writing, ‘This Old Man' is Agnell's reflection on life, starting ith what is...
Palliative Care: Doing ‘nothing’ is not an option
Dr Daphna Grossman wants to set the record straight “In healthcare it seems we talk about ‘doing everything’ or ‘doing nothing’. With Palliative care ‘nothing’ is not an option.
Infections in the elderly how to best treat: Are antibiotics always the answer
Although my 96 year old aunt (pictured at left, between me and my cousin – her daughter) had no symptoms of a bladder infection, a urine test resulting from cloudy pee revealed she indeed had a Urinary Tract Infection (UTI. My aunt hadn’t complained about pain or discomfort, my cousin – her ‘power of attorney’ – authorized treatment with antibiotics. Many would agree.
10 ways to think creatively
What if what you want until you die can’t be done exactly as you imagined?
Consider it an opportunity for creative thinking.
Medically Assisted Dying: the benefits of the process
When medical assistance in dying – MAID (also referred to as Medically Assisted Dying – MAD and Physician Assisted Dying – PAD ) was just a twinkle in eye in most of North America, I began my layman’s journey into learning all things end of life – encompassing much more than ‘help me die’. Now, with medical assistance in dying taking center stage, I’ve made it my business to attend every Town Hall, Presentation and Info session.
Elderly and Sleep
We need less sleep as we get older. Everyone knows that right? Wrong! Completely and utterly wrong.
The myth that the need to sleep drops as we advance in years is one of those random misconceptions that somehow takes hold and persists – kind of like how if you eat something within five seconds of it falling on the floor it will be fine. No, it won’t.
Ricky’s mother had a ‘good death’
Of the three siblings, Ricky – the sole daughter – was closest to her mother, Anna. “When my marriage ended, my kids and I lived with my mother. We all adored her.” In the last three years of her life Anna- who died at age 91 – was beset by Dementia. “It was more than memory loss – it was her wonderful personality that vanished.” In spite of the pain of her beloved mother disappearing, Ricky took care of her until the end.
A doctor is surrounded by people who are sick, discouraged, afraid, embittered, dying – but also courageous, loving, wise, compassionate and alive.
