senior decisions

With all the recent focus on what is now called advance care planning (ACP) in the medical and social work literature, it is important for people, especially middle-aged and older people, to understand what is at stake.

Using the old terminology of a “living well” there has been a transformation from what used to be a few words in a document somewhere or as a conversation with the family member likely to be the substitute decision maker (SDM), that, for example, the parent “would not want any heroics” if developing a terminal illness.

The reality is that it is no longer enough to help those empowered to make such decisions on your behalf. The new world of medicine has many things that can be done that are no longer considered “heroics” but just part of contemporary every day medicine.

So a number of suggestions:

1) make sure your SDM can honestly and emotionally carry out your wishes;

2) try to be specific about those life-prolonging interventions that for sure you would not want–such as a permanent feeding tube if you are not conscious enough to appreciate food or those around you;

3) make sure in addition to writing a document, to have the conversation with those you decide you would like as your SDM;

4) get advice from a trusted doctor and lawyer as what you might want to include and how to frame a document if you want to write one.

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Dr. Michael Gordon MD, MSc, FRCPC
Dr. Michael Gordon, MD, MSc, FRCPC and FRCP(Edin) is medical program director of Palliative Care at Toronto's Baycrest Geriatric Health Care System and professor of Medicine at the University of Toronto. He an educator and author and is involved professional and public education. An American by birth, he is a graduate of the University of St. Andrews Medical School in Scotland. His pre-specialty training included Internal Medicine, Obstetrics and Gynecology and Nuclear Medicine. He came into geriatrics in Canada where he settled after much world-wide travelling for his medical training in 1973. He came into geriatrics by a confluence of unpredictable events prior to it being recognized as a medical specialty in 1981 at which time Dr. Gordon received the first certificate in Geriatric Medicine awarded by the Royal College of Physicians and Surgeons of Canada. His career has included a wide range of clinical activities in eldercare, which for years included responsibilities at Toronto’s Mt. Sinai Hospital. His main commitment has been to the Baycrest Geriatric Centre where he served for many years as its Vice President of Medical Services and Head of the Department of Geriatrics and Internal Medicine. He currently devotes his clinic and administrative and educational activities to Geriatric out-patient care, in-patient palliative care, medical ethics and end-of-life planning, communication and care and writing for the lay and professional press. His books include his first book Old Enough to Feel Better: A Medical Guide for Seniors which went through three editions; An Ounce of Prevention: A medical guide for a healthy and successful retirement; The Encyclopedia of Health and Aging; Parenting your Parents (two Canadian and one American edition); Brooklyn Beginnings: A Geriatrician’s Odyssey; Moments that Matter: Cases in Ethical Eldercare; and most recently Late-Stage Dementia: Promoting Comfort Compassion and Care and now the revised third edition of Parenting your Parents: Straight Talk about Aging in the Family. For more information see drmichaelgordon.com

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