Two important considerations in these healthy conversations about your life are 1. the factors related to one’s decision making capacity and 2. the issues about end of life. 1. When it comes to your wellness decisions, you are presumed to have a) understanding, b) appreciation, c) reasoning and d) choice. A.) Understanding involves you as the patient explaining in your own words the risks, benefits and alternatives with respect to the given treatment. B.) Appreciation is recognizing that the diagnosis and treatment affect and apply to your specific situation here and now. C.) Reasoning means that you are able to process the information rationally and formulate options based on your values and their future consequences. D.) Choice entails picking an option based on the foregoing process and your willingness to abide by that choice. As we will see shortly, when your decision making capacity is insufficient in conversations about your physical and mental wellbeing, the critical principle of autonomy ceases.
2.) Whenever the conversations deal with end of life, the basic dilemma encountered is whether you as the patient want aggressive treatment to sustain life, none at all or something in between. In other words, we are addressing advanced care planning and directives, and their legal instruments such as a physician order for life sustaining treatment (POLST), a living will and a durable power of attorney (DPOA) for healthcare and another for finances or maybe both are combined. The California POLST discusses CPR along with other medical interventions that a patient would like; and it complements the advanced directive. The living will also informs us of the individual’s preferences concerning end of life treatments. It is a legal document that conveys what a person wants and does not want, and it could be general or even specific but still could miss some of the countless contingencies. A durable power of attorney for healthcare names someone as the new decision maker when the person in question becomes incapacitated, that is, they no longer can make decisions for themselves. Sometimes a DPOA may indicate effectiveness before incapacitation depending upon your choice of legal wording. The DPOA for financial matters affects only monetary decisions. It is pertinent that you and the doctor make sure that the correct person in charge is not waving the durable power of attorney for finances and assuming it is applicable to healthcare decisions or vice a versa. Needless to say, because we are dealing with the end of life, California law demands written instructions clearly identifying the advanced directive.
These two points, that is, the decision making capacity and end of life issues, are fundamental in the discussions that you have with the important people in your life concerning your healthcare. Not only is your family and doctor important parties in your discussion, but also the counsel of an elder lawyer should be used. We will discuss this further in our legal section.