Making Difficult Life & Medical Decisions presentation at the FSGA Annual Conference 7/17/10

Viki will be giving a presentation at the Florida State Guardianship Association’s (FSGA) Annual Conference on 4 Tools for Making Difficult Life and Medical Decisions on 7/17/10 at 10:50am.

FSGA is a nonprofit corporation founded in 1983 for the improvement of guardianship services. Governed by a Board of Directors representing five geographical areas of the State, FSGA is dedicated to promoting the protection, dignity, and value of incapacitated persons through ethics, advocacy, and the dissemination of information.

FSGA’s mission also includes a focus on furthering the professionalization of guardians as accountable court representatives through education, networking, and legislative action.

Guardianship is the management of the affairs of someone who has been judged unable to manage their own affairs. Generally guardianship is ordered by a court on behalf of someone who is called a ward of the court. A guardian assumes the rights of the ward to make decisions about many aspects of daily life. A guardian is directed by ethics and statute to make decisions in the best interest of the ward.

FSGA members include professional private guardians, corporate guardians and fiduciaries, attorneys, social workers, care managers, government agency and court staff and others interested in the support and advancement of guardianship services and alternative protective services.

Have a kind and respectful day.

The medical decision is just part of life’s equation.

So many people ask me what they should be thinking about when making medical decisions. Whether you are making your own decisions or having to make decisions for others, there is a lot to think about.

Your doctor or your loved one’s doctor will talk to you about the medical aspects of any health-related decision. But that doesn’t mean that you are limited to thinking only about medicine. It may be important to consider the financial costs associated with the treatment plan, if the patient’s religion should play a role in the decision and whether there are cultural issues that come into play. Think about the overall picture of your loved one’s life. In The Caregiver’s Path to Compassionate Decision Making, I offer lists of questions to help you understand the whole picture.

It would be nice for the decision to be as simple as asking, “Will the treatment work and what are the side effects?” But life isn’t that simple. What if you were about to make a medical decision that allowed something to be done to the person’s body that was forbidden by the person’s culture or religion? You might have chosen a certain treatment to save her life, but because the patient received that treatment, she will no longer be able to move on to the hereafter. Yes, the medical decision was a good one, but how the decision will affect the person’s life, based on her personal belief system, was not.

If the person you are making decisions for is very religious, then it would be good to find out if there are any religious rules or values that you should consider in your decision making. I know that when I work with my hospice patients, it is important to know if there are certain rites or blessings that have to be performed before the patient’s death. I don’t have to agree with what the person wants, but if I am the caregiver, then I need to do what I can to make sure the person’s religion or culture is respected. I will need to call in the appropriate religious leader to take care of the spiritual needs of this person. If the person is not religious or spiritual, then you will need to respect this and leave religion out of the decision making process.

For most people, the financial costs of the medical treatment will need to be considered or you may be putting the person in financial danger. You may be in charge of making only the healthcare decisions, but you should make sure that you or somebody else checks with the insurance company to find out whether or not it will pay for the treatment and to get the proper authorizations. Don’t let a simple mistake like forgetting to call the insurance company to let them know that your loved one was admitted to the hospital put your loved one in financial distress. Making decisions without using the financial questions could bankrupt your loved one. Our goal of protecting the person should include protecting his or her wallet.

For a list of questions you can use when making decisions, go to the resource page and download the list from the excerpts from The Caregiver’s Path to Compassionate Decision Making - Making Choices for Those Who Can’t.

Have a kind and respectful day.

Patient’s Rights - Where do they start and where to they end?

What are our obligations to the patient? Keep in mind that autonomy only works with people who have the capacity to make their own decisions.

Here are some of the patients’ rights that come with using autonomy:
• Patients have the right to receive all the information they need to make a good decision.
• Patients have the right to make their own decisions.
• Patients have the right to refuse treatments they do not want.
• Patients do not have the right to demand treatments that will be medically ineffective or are medically inappropriate for their condition.

It is important to realize that there are limits to a patient’s rights. A patient is limited to asking only for treatments that will benefit her. This limitation makes sense. It would be pointless, and potentially harmful, to provide a treatment or medication that would not improve the patient’s condition. So, as a physician, you are able to say no to practicing bad medicine. If what the patient or decision maker is requesting would be inappropriate or non-beneficial you can say no and protect the patient. But if it is a medically valid option, even when you disagree with what the person wants because you think they are being foolish or it isn’t the best option to choose, we have to respect that it is the patient’s body and life.

I know this can be difficult as you watch people making foolish choices. But that is autonomy. All of us, including you, are allowed to make the decisions that make sense in the context of one’s own life. (Of course, there are different boundaries in pediatrics.)

One technique I use with patients is to say, “Here is the ideal plan. Now let’s talk about your plan.” That allows the two of you to partner together to build a plan, although it might not be ideal, it is something the patient is willing to consider and to try. And then perhaps in the future, the patient will be willing to consider the other options you would like him or her to try.

Have a kind and respectful day.

Autonomy and Patient’s Rights

Autonomy means that a person makes his own decisions, so it only works with people who have the capacity to make their own decisions. If you have determined that your loved one still has capacity, then this is the correct decision making option. With Autonomy, the person gets to say what should be done to his body.

When I went to my doctor to talk about my injured back, my doctor told me what options were available to help me get better. He said I could try physical therapy, have a cortisone injection in my back, or just wait and see if it got better over time. Because I had the ability to think for myself and to make my own decisions, I was able to choose what I wanted to do. I got to think about the different options I was given and then make my own decision. I had Autonomy.

Here are some of the patients’ rights that come with using autonomy:
• Patients have the right to receive all the information they need to make a good decision.
• Patients have the right to make their own decisions.
• Patients have the right to refuse treatments they do not want.
• Patients do not have the right to demand treatments that will be medically ineffective or are medically inappropriate for their condition.

It is important to realize that there are limits to a patient’s rights. A patient is limited to asking only for treatments that will benefit her. This limitation makes sense. It would be pointless, and potentially harmful, to provide a treatment or medication that would not improve the patient’s condition.

Keep in mind that autonomy only works with people who have the capacity to make their own decisions. If you have determined that your loved one does not have decisional capacity, you will have to use different tools such as Substituted Judgment or the Best Interest Standard. (I will cover these two later this month.)

Have a kind and respectful day.