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Who Will Call The Shots For You

Author : Maricruz Ferrari LCSW

There he was lying in his hospital bed, his eyes full of despair, agony, and confusion. Unable to express his thoughts or his feelings he appeared restless like trying to find unachievable comfort. His daughter was sitting at his bedside looking at paperwork and making phone calls, very task oriented. Caregiver’s exhaustion was visible in her eyes, but no complaining. I walked into the patient’s room hoping to discuss the dreaded topic, end of life decisions. I smiled gently at him in an attempt to connect, but all he could give me was a blank stare.

The daughter welcomed the visit and the conversation. It seemed like it had been a long time since she last got to unload her overwhelming feelings. Her affect was flat, but her comments were intensely charged. In a way she had gotten used to the new norm, being in hospitals and facilities constantly. She had become immune to the shock and anxiety that comes with having a loved one in a hospital. How could you blame her, you have to develop some sort of coping skill to be able to ride the rollercoaster that is the health of a chronically ill patient. She openly shared all the struggles the patient had faced during the last year and the countless hospitalizations he’d had. He had more medical issues than I could count on my two hands, and she was aware his health was in a rapid decline. We discussed end of life choices and decisions. I tried to tell her how invasive/aggressive measures could hurt him more than help him. I’m not sure she truly understood his suffering. She listened carefully, but her tunneled focus was to keep moving forward and providing all possible treatments to keep him alive. She kept repeating he was a strong man and things would turn around. Yet, as she told his story, she clearly understood how the man who was lying in bed didn’t resemble her father in any way. Needless to say, the patient kept receiving treatment until his body no longer responded to it, which was a few days after our conversation.

Families often struggle with denial when they first hear bad news about their loved ones. Yet, they usually manage to process the information, analyze choices and make decisions that may or may not be appropriate for the patient. Sometimes denial is so intense, or there are unresolved issues that impede the family members from making decisions that are appropriate for the patient. In these cases, families have difficulty deciding when to let go and they may stay in one gear the whole time, keep trying even when there’s nothing left to try.

Choosing the right person to make decisions for you is crucial. Hopefully, you will be able to make your own healthcare decisions until your last breath. However, if you’re not, you want to make sure the person who takes over can respect your wishes. You want someone who can show love and compassion, but at the same is ready to make hard decisions to protect your dignity and integrity.

It is probably not recommended to designate someone who has difficulty with decision making or someone who has unresolved issues with you. History of emotional problems with the patient can translate into guilt, insecurity and despair when making health care decisions. Financial issues can be a source of conflict too. Therefore, someone who might have a financial interest in your life should not be your decision maker.

Several documents are available to designate a decision maker. Some of these documents include advance directives, durable power of attorney, living trust, etc. Standard forms can be found online. If there are no legal documents hospitals will consider a default decision maker. In most states, the default decision maker is a next of kin, typically starting with the patient’s spouse. If there is no spouse, the next in line would be adult children, parents, siblings and rarely other relatives. The state of California is one of the few that recognizes a non-relative as a decision maker as long as they are close to the patient.

People who have no next of kin or friends may have a legal guardian or conservator. If no legal decision maker is appointed, the patient will have to be referred to a hospital’s bioethics team, which will represent the patient while at the hospital. The bioethics team will review the patient’s medical condition and treatment options. They will try to make an objective decision based on the patient’s best interest.

Give it some thought. If you could not make health decisions, who will be the one calling the shots for you? Make sure it is someone who will advocate for you when treatment is needed, but will also advocate for you when treatment is no longer appropriate.

One more thing! Don’t forget, always communicate your wishes openly to those close to you!

Author's Resource Box

Maricruz Ferrari is a Licensed Clinical Social Worker who has worked in healthcare for multiple years. During the most recent stage in her career, she has provided supportive services to people on the end of life journey. Along the way she has learned there is a significant unawareness in the community about end of life choices. It is often people go through intensively difficult medical experiences due to lack of knowledge. Maricruz wants to create more awareness over end of life issues and choices with the purpose of helping people be more prepared for the last chapter in their physical.

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Tags:   end of life, death, social work, hospice, Clinical Social Worker, healthcare, life choices, medical choice, end of life care, end of life care options, end of life care hospice, end of life planning, end of life planning, end of life decisions, living will, doctors, questions, clear explanations

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Submitted : 2019-02-07    Word Count : 820    Times Viewed: 65