|
DECISION MAKING
FACING THE DIFFICULT ISSUES
A diagnosis of Alzheimer's Disease or another dementing illness will mean that a number of difficult issues will need to be confronted and decisions made. Decisions do not all have to be made at once. Sometimes having discussed the difficult questions and considered the possibilities before a decision really has to be made, can help. Decisions are best made through open dialogue between the person, family members and health-care professionals and when individual and family values, culture and religion are taken into consideration.
Staying Involved
The disease is a degenerative one with behaviour and abilities altering as the disease progresses. As the disease progresses, the affected person gradually becomes unable to make decisions. However, a diagnosis of Alzheimer's Disease does not necessarily mean that a person is immediately unable to make decisions. A sense of being involved in making decisions and controlling one's own life are important for physical and emotional well-being. Not all decisions will concern major care issues. Involvement in determining the ongoing details of daily life can help to maintain feelings of independence and self-esteem. All those who provide care and assistance need to ensure that, while still capable, the person with Alzheimer's Disease should be given choices and the opportunity to make decisions.
Planning for the future
It must be recognized that a time invariably comes when decisions must be made without direct input from the person with Alzheimer's Disease. Ideally, future care decisions should be made before brain damage prevents a person from sound decision-making. This may include a legally recognized document (advanced directive, a living will or enduring power of attorney) that communicates a person's wishes about the desired type of care and/or medical treatment should that person be incapable of making that choice in the future. This may include naming a specific person(s) who will make decisions on their behalf should they become incompetent to do so themselves. The assessment of competency and/or a person's ability to make certain decisions (for example about financial affairs or health-care treatment) may be regulated by different laws in different countries (in some cases, states or provinces).
Conflicts of interest
There are occasions when the expressed wishes of the individual are in conflict with the interests of the family or society. For example, a person with Alzheimer's Disease may wish to live independently at home or to continue driving, but this may be considered to place both the individual and others at risk. As the disease progresses, more and more decisions will have to involve others - family members, authorities and health-care professionals. Some issues can cause emotions to run high, especially when family members are called upon to make decisions on behalf of the person with Alzheimer's Disease. On such occasions, outside authorities or agencies can be of great assistance. Where possible, the desires of the individual if clearly expressed in an advanced directive, should take precedence.
Difficult decisions
There are a number of difficult issues that all families and/or authorities will have to confront at some stage. We have provided some information about factors to be taken into consideration in making decisions about the following matters
|
