Joseph remembered how his mother disapproved when an elderly neighbor was put on a similar machine after a stroke. The doctor asked Joseph if he wanted that to be done. The doctor said damage to Leilani’s brain was widespread and she needed to be put on a breathing machine (ventilator) or she would probably die. Joseph’s 90-year-old mother, Leilani, was in a coma after having a major stroke. These two approaches are illustrated in the stories below. This is sometimes combined with substituted judgment. Another approach, known as best interests, is to decide what you as their representative think is best for the dying person. Some experts believe that decisions should be based on substituted judgment whenever possible. One is to put yourself in the place of the person who is dying and try to choose as they would. Two approaches might be useful when you encounter decisions that have not been addressed in a person’s advance care plan or in previous conversations with them. Decision-making strategies: Substituted judgment and best interests Hospice staff can help determine whether a medical condition is part of the normal dying process or something that needs the attention of health care personnel.įor situations that are not addressed in a person’s advance care plan, or if the person does not have such a plan, you can consider different decision-making strategies to help determine the best approach for the person. If end-of-life care is given at home, you will need a special out-of-hospital order, signed by a doctor, to ensure that emergency medical technicians, if called to the home, will respect the person’s wishes. If the person has written documents as part of an advance care plan, such as a do not resuscitate order, tell the doctor in charge as soon as possible. Addressing a person’s advance care wishes This can be overwhelming for family members, especially if they have not had a chance to discuss the person’s wishes ahead of time - or if multiple family members are involved and do not agree. If the person can no longer communicate, you may be asked to make difficult decisions about their care and comfort. You may wonder how you can comfort the person, prevent suffering, and provide the best quality of life possible in their remaining time. You are probably reading this because someone close to you is dying.
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