Decisions are not all equal opportunities
We all have different views or opinions. Even when we seem to agree, there are some differences, so where does this difference of opinion leave us? These differences are not as troubling when they are about what’s for dinner, when to wash laundry and so forth. However, what happens when the differences are about what kind of medical attention and how long to continue providing life-sustaining measure, when there is little or no medical standing for recovery.
Let’s start with an active early sixties female discovers she has a diagnosis of terminal cancer. Among her immediate family is a son whose profession is Medical Doctor. The female patient does not want treatment for the terminal cancer. The son strongly disagrees with this and is willing to arrange whatever means necessary to help facilitate this care. Families and medical providers face this situation everyday.
This scenario of an older adult and her son, who is a doctor, is seen frequently, especially when the adult child is a well-educated professional whom the older adult has deferred to in the past for other decisions. Please note we are not discussing a person (the mother) who has any diminished capacity, per her medical doctors. And this is perhaps why it is best to have family discussions earlier than later regarding the eldercare and medical decisions. This situation has many emotional entanglements and the shock of a devastating diagnosis.
This is not the time for the discussion, although better late than not at all. Adult children are living in a world of new medical breakthroughs and technology far beyond expectations of elders. Human emotions and decisions are based on life experience and education. This patient had been diagnosed with a disease that was incurable and debilitating a number of years prior to the diagnosis of terminal cancer. Her life had been spent in great productivity raising a family, having a career, an advocate within her community and more. She had been independent, self-sufficient and traveled for a number of years.
Her children (her children three sons all professionals in various arenas) are lobbying because they want to have just a little more time with her. They were aware of the decision being her wishes and that she had the cognitive ability to make this decision, but still in disbelieve and some confusion could not fathom the decision of no intervention. Now the adult children will need to play catch-up. Decisions, such as this do not have to be open for discussion down to the last period on a piece of paper; however a discussion among adults prior to a diagnosis would be better. Certainly, the adult children are being bombarded by emotions well above any they have experienced before. The lost of the being held so close, nurtured, educated and loved them no matter what is akin to having been abandoned in a world without humans.
The same situation when her husband was brought to the table was different. He is (a medical professional) confused also, but because he is still not in total realization of the illness. He hears the words ‘terminal cancer’ but can’t equate it to his wife, a woman he has been with for a great number of years and only in the last years has separated and remarried. This is the woman who gave him children, stepped up and ran the household, met all the qualification of a CEO within their marriage. How could she now abandon him to pull all together and expect him to meet the needs of their grown children?
As we can see a conversation earlier in life, perhaps around a living room while having some hot chocolate and catching up on family business with all present, would have planted a seed of knowledge. There is no need for graphic conversation, but perhaps a discussion surround end-of-life issues and care would have help make this somewhat easier for the adult children. Knowing their mother had thought through the consequences of her actions, the possible new break thoughts in medicine and the developments of her other disease process which is life limiting.
Each one of us needs to look at our own life and the perimeters surrounding it, then give some thought to what we would do and share this with family. This scenario is taking place everyday in our country. When set in motion the emotions are so overwhelming it is most difficult for families to make a well thought out decision. In the above case, the woman asked for a Medical Power Attorney rather than to leave this most difficult decision to any of her family members. And all family members were told who was the medical decision maker and who was the Executor of the Estate.
Next week, the topic is driving. Who makes the decision to take away the driving privilege and when.