consent _conflictConsent, 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’

Dr. Michael Fratkin is an enabler

“Most of my healing has little to do with medicine.” “My approach has more to do with being there, listening and helping people with a different approach.” Fratkin, entrepreneur creator of Resolution Care, is a Palliative doctor

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Extreme Measures: Dr Jessica Zitter on a Palliative mission

“I’m going to call 911: a doctor is torturing a patient.” So said Nurse Pat Murphy to Dr Jessica Zitter  – just as Zitter was about to plunge a syringe into the neck of a patient with a host of health issues. Tho the 911 call wasn't made, it was a turning point for...

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Vial of LIFE

What is the Vial of LIFE Program It may sound like the fountain of youth, or miracle life-saver in a vial. It is neither. Instead, it’s information about your health care and wishes, stored in your fridge with a fridge sticker to announce its presence. LIFE stands for Lifesaving Information for Emergencies The Vial of LIFE sticker on your fridge alerts Emergency Response Teams (EMS) Paramedics and other health care providers who may come to your home

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Dementia – more than memory loss: it’s a broken brain

Dementia: Communication, hard-to-manage behaviours and safety A much needed re-framing of Dementia from Alberta Health Services clinical nurse specialists, Jennette Coats and Loralee Fox, who embrace care and caring for those with ‘broken brains’. I sat in on their...

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Coalition for Compassionate Care Summit with ePatients

  ePatients: Engaged and Empowered and Invited The Coalition for Compassionate Care of California (CCCC) promotes high-quality, compassionate care for everyone who is seriously ill or nearing the end of life. What a human-centered, patient-centered goal. And now,...

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High Risk Surgery: Best Case, Worst Case

Decision tool to help understand chances of dying after high risk surgery “People worry about ‘dying poorly’, so one of the reasons for agreeing to surgery is the mistaken belief they’ll likely die - peacefully - in the Operating Room. This rarely happens.” Dr...

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Connectivity and Cyber Seniors

Cyber Seniors: the growing internet demographic For the legion of cyber seniors, age 60-90 who rely on internet access to stay connected,  it will come as no surprise that I put forward, in a recent tv panel, ‘internet for free’  for the elderly and low income as a...

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Palliative Home Visits are the Future

“What I fear the most – what really terrifies me – is being short of breath and not being able to swallow.” So said the husband of his dying wife. This is terrifying to me, too, so I listened closely to the response given by Palliative Care  physician, Dr Sandy...

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Death and doctors who don’t want to talk about it

What happens when patients want to talk about death, but their doctors don’t? My 94 year-old father-in-law was relieved and delighted when I brought forth the subject of medical directions, in the event he couldn’t speak for himself. My brother in law – a paramedic –...

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A doctor is surrounded by people who are sick, discouraged, afraid, embittered, dying – but also courageous, loving, wise, compassionate and alive.

Dr Bernie Seigal

The Hug Doctor