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’
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...
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 –...
Grief and relief: tradition, culture and religion
In this fast-forward world, it can seem that grief should have a ‘best before’ date. It can be uncomfortable – for those grieving and those around. Grief can also be exhausting and stressful and relentless. Considering few of us are spared the knife-cut that comes...
Comfort: How important is it to you at life’s end?
For many – perhaps most – suffering is the biggest worry about life’s end. Suffering doesn’t start and end with pain management. It includes peace of mind and comfort – both of which are highly individual, and can hold the keys to perception of and requirements for a...
A new medical decision PATH for the frail elderly
Palliative and Therapeutic Harmonization: PATH In plain language PATH means an assessment and treatment recommendation that takes into account what’s going on with us as a whole person, rather than our specific parts. A worthy goal for all of us, but with particular...
Bringing Creativity into Clinical Practice with Older Adults.
It was a day of music, arts and drama, of passion and compassion, entitled, Bringing Creativity into Clinical Practice with older adults. Bringing creativity into a Clinic Day brought relief and hope to many working with Dementia and Alzheimer's patients. The...
Room 217: Care Through Music
Guest blog by Bev Foster A lot of life happens in rooms and so does a lot of death. One room I will always remember is Room 217, where my mom, five siblings, and I sang around dad’s bedside as he was dying in a hospital northeast of Toronto. Whether it was the...
Medical jargon: even single-syllable words can confound
Who’d’ve thought that simple, one and two-syllable words – which is one of the the criteria for Grade 6 reading level – could cause so much confusion, upset and medication errors. Out of context, even every-day words can confound. Consider these (true) examples: In a...
Grief and Grieving: death, dying and beyond
Grief and grieving: in life and death For each of us, our Book of Life has many chapters on grief and grieving, covering a broad spectrum: I can still conjure the pang of loss when my youngest went to Kindergarten; the sense of betrayal caused by the end of a...
As we age, do we become too thin-skinned?
In a word: Yep. Our skin thins and gets dry Thin, dry skin often gets itchy. And that can lead to a mess of problems. Hence, the expression: thin-skinned. Perhaps not as talked about as the other issues of aging, but should be – considering how much skin we have. Dr...
A doctor is surrounded by people who are sick, discouraged, afraid, embittered, dying – but also courageous, loving, wise, compassionate and alive.
