Many patients reach an advanced stage of dementia but have never completed a clear and specific Living Will. Some completed an ineffective or irrelevant Living Will; others did not complete any Living Will. Still, physicians will often consider their relatives and loved ones as their surrogate decision-makers and may ask them to make life—determining decisions.
What is the best way to handle this difficult decision? Traditionally, one physician asked one selected surrogate to make one decision, and hoped it would reflect what the patient wanted. There is, however, a better way. This way is more likely to reflect the patient's real wishes and may also put less stress on the one individual asked to make this difficult decision.
This option asks several people who knew the patient well before he or she became ill, including the values s/he treasured and how she made previously treatment decisions.
Each person will then use the cards to see if all can reach a Consensus for Substituted Judgment (Now Care Planning).
If all concerned sort the cards and can agree on the 48 conditions, then they will likely be able to agree on the decision the patient's physician is asking about (even if the patient's condition is not exactly on or a combination of these 48).
Sometimes people forget how that they are supposed to make the decision that the patient would have made—not the decision they would make, for themselves. Sometimes people have a conflict of interest and that biases their decision.
In these situations and others, there may be “safety in numbers.” If one person makes a decision that differs from all the others, that can be discussed, perhaps with a counselor.
Since all concerned share making the decision, they may feel less anxiety, uncertainty and guilt.
*When it's too late for Advance Care Planning.