Taking the Agony out of Decision Making

“Taking over”, “parenting your parent”, “from spouse to caregiver” One of the most agonizing and exhausting parts of caring for a family member is making decisions when your family member cannot make them for himself. Many families have the further confusion of helping a loved one who is capable of making decisions on a day when he feels good and not capable of making decisions the next day when he doesn’t feel good.

The truth...most of us error on the side of giving our family member too much decision making capability for too long until finally some type of crisis forces us to take action.

As my Girl Scout leader used to say, “Previous planning prevents poor performance.” Encourage your family member to put proactive tools in place that let him make decisions while he is sound of mind.

Individuals can appoint family members or friends to manage their day to day living arrangements, health care and financial affairs by drafting durable powers of attorney for healthcare and powers of attorney for finance. Individuals with living trusts appoint successor trustees who handle financial issues. Once the tools are in place and the time has come to use them, another set of challenges comes into play. How will you make the best decisions possible for your family member?

I’ve found a wonderful new book written by bioethicist Viki Kind, “The Caregiver’s Path to Compassionate Decision Making”. Kind combines her professional knowledge (as a bioethicist she helps medical professionals and families make decisions) and her personal experience of caring for her parents to give families a guide to making difficult decisions. The book explains what I would call different layers of decision making and guides you through the steps to making sound, respectful decisions.

Kind introduces the concept of “mental” age that I found very helpful. Her explanation helped me understand that a family member may be operating at a mental age that does not give her full access to reason. Knowing that your family member cannot reason her way through a decision or appreciate the full consequences makes it easier to intervene.

In the “Caregiver’s Path”, Kind explains the mental age ranges and the decision making capabilities associated with each. Mental age 0-6 years - Parent or decision maker will make the decision for the person. Mental age 7-13 years - Decision maker will make the decision and gain the assent or permission of the person being cared for. Mental age 14-17 years - Person being cared for makes the decision. Your family member’s doctor can assess his/her mental age.

Other factors that Kind encourages us to take into consideration are the importance of the decision. Is the decision life threatening or life altering? Has the person made his/her preferences known through conversations and health care directives? How long is your family member’s lack of capacity to make decisions likely to last?

I’ll be keeping this book on my bookcase and using the concepts with my clients. It’s well worth buying or checking out from the library if you will be making decisions on behalf of a family member.

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