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Medical Decisions for end of life care

It’s estimated up to 40% of hospitalized patients do not have the mental ability to make key decisions about their health care because they are “unconscious, delirious, demented or otherwise cognitively impaired.” Unfortunately, if these medical decisions are for an older person who may be nearing the end of their life they become increasingly important.



No one likes to talk to their parents or loved ones about end of life medical decisions. So what happens? Most of us avoid the conversation and when the time comes we have no idea whether our loved ones have an advanced directive or where it is if they do have one.

Medical decisions how are they made?

Whether it’s about life-sustaining treatments, surgery or other medical decisions, research indicates that medical decisions are often made based on the judgments of the caregiver rather than what the patient may have wanted. In fact, researchers from the Journal of Clinical Ethics, have categorized decision making strategies as “patient-centered” or “surrogate-centered.”

Patient centered medical decisions are based on what the caregiver believed the person wanted. Although the patient may not have created an official “directive,” the caregiver or surrogate may have relied on past conversations with their loved one or made decisions which they believed were in the patient’s best interests, after consulting with a doctor.

Obviously, this strategy has some flaws. It is often difficult for some caregivers to make end of life medical decisions or they may choose the wrong option because they did not understand the patient’s preferences.

What are surrogate centered medical decisions?

But what if you have no idea what your mom or dad would want? Researchers note that in this case some caregivers turn to what they term surrogate centered medical decisions. Using this approach, the surrogate will determine what they would want done to them in a similar situation- also known as the Golden Rule. Other surrogates relied on principles from their own spiritual beliefs or sought opinions from other members of the family. One researcher noted this could be one way for the caregiver to avoid feeling guilty.

Considerations near death

What is obvious for anyone who is getting older is that they need to think carefully about who they select to make medical decisions for them in the event they become incapacitated. Finding someone who is like-minded and who has similar spiritual beliefs can be beneficial. It is also important to have conversations with your family and talk to them about how you desire to live your life. This may not be one conversation but an on-going dialogue as your health situation evolves. One thing is certain, even with the right medical directives it is impossible to write down all possibilities, so finding someone you trust is crucial.

Next, make an advance directive and distribute copies to anyone who may be involved in end of life decisions for you, including your doctors.

Finding a disability lawyer

Remembers, if you have a severe health condition which does not allow you to work you may qualify for Social Security Disability Insurance, which is a wage replacement program offered by the SSA.
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