Saturday, December 31, 2011

Dilemma: Your opinion whether it’s been asked for or not

Think of a good friend, or family member and asks yourself how you would respond if they asked for your opinion on something they just purchased. Chances are you would probably be fairly honest in your reply. Now think of this same person. They have a very serious health crises and they ask you “Do you think I should have treatment?”

Reverse the process and think about the times you’ve asked others for their input? Did you want an honest answer or were you just wanting them to collaborate what you were already thinking or planning to do?

There are multiple things that come into play when we ask for input or our advice is being sought. A lot of the responses come down to the people involved, the situation and the level of honesty in the relationship.

I’ve had reason to belabor these questions because of several recent situations where people are asking friends, family and the occasional provider, about how they should be managing their health care. There is no simple answer when someone asks if they should continue treatment, have surgery, opt for hospice, move to assisted living or enter a clinical trial. These are major life altering choices and so it is important to weigh your answers carefully.

When faced with such a question(s), consider the following:

• For people with chronic and life threatening conditions, the provider will expect the person and/or family to make the choices and decisions about type of care and treatment and when and when not. If a person is dealing with pain, metastases disease, malnutrition, dementia or anything else that may alter their thinking, they may be in a very difficult position to make such choices. These are very challenging situations. If a friend or family member asks your opinion, help facilitate discussion by responding honestly, recognizing that they, more than anyone else, has to live with the consequences of the decision.

• Sometimes people will ask not only for opinions but also make requests of you, which are illegal. It could be a matter of obtaining medical marijuana, which may be illegal in your state. Over the years, I’ve known many people who have said that if they became too ill, senile or are in considerable pain, they want their family to terminate their lives or they will do it themselves. These are definite ethical issues, which need to be weighed on a case-by-case basis. Below are resources that might be helpful:

Resolving an Ethical Dilemma

Top 50 Medical Ethics Blogs

Medical Futility Blog: Has an excellent list of links on medical ethics.

• What weight might your response carry in their eyes? In other words, do they consider you a valued and trusted person whose advice they have sought before?

• What about the situation where you see a good friend/family member who is in real trouble with their health care? They may not be asking for your advice, but you also don’t want to stand by and watch them damage themselves. When or do you intervene? This can be an incredibly difficult situation. Step one is to let them know of your concern. If they respond negatively, your options are limited. Again, what is your relationship to the person? If there are people closer to them, such as a spouse, partner, parent or adult child, talk to them. They may share similar concerns and together you may be able to come up with strategies to intervene. If you are the caregiver, and have permission from the patient to speak with the provider, talk to them. Even if you don’t have permission to talk with the provider, you can contact them and relay your concerns, basically having a one-way conversation. If you truly believe that this person is a danger to self or others, you can call adult protective services and report the situation.

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