End of Life Care: Understanding Consent in Seniors

When a senior is facing end of life, there are many decisions that have to be made. But one may assume all the decision making falls to the family. While this is certainly true in the case of elders who can’t make their own decisions due to the extent of their illness, often times they can and should be a part of the decision making process. To do that, it’s necessary to understand how consent in seniors works. How do you even know if your parent, spouse or other loved one is capable of making critical choices? It may be time to have those important conversations.

Mental Capacity

Legally, informed consent involves the ability to receive and understand the consequences of an action before offering authorization. You need informed consent before major medical procedures, before releasing medical records, and deciding on an end of life plan, among other circumstances. Informed consent is very much entangled with mental capacity. Does the senior have the mental capacity to understand the nature of the treatment AND understand the consequences of their decisions? For example, during physician-patient communication, says NCBI, the alternatives, as well as the risks and benefits of not receiving or undergoing a procedure, should also be disclosed.

In a perfect world, every patient should have a designated person in the family to whom all estate and personal planning decisions should go in the event they can’t make their own decisions. However, there’s a fine line as to when and if that has occurred. Making the determination of when a person can’t give their own consent is fuzzy at best.

Determining Consent and Capacity

Just because a patient has been diagnosed with dementia doesn’t mean that can’t necessarily make their own healthcare decisions. For example, one person who has been recently diagnosed with dementia can be deemed competent to make their own decisions, while another may not be able to, due to the advanced progression of their disease whereby they have lost mental capacity. That’s why the determination is so personalized, and should not be made without the input of a physician.

Here’s a checklist of sorts for determining consent and capacity. Does the senior:

1. Have realistic expectations?
2. Understand the nature of the treatment?
3. Have the ability to communicate his or her choice?
4. Know how to discuss the received information rationally?
5. Have awareness of the possible outcomes of treatment or lack thereof?
6. Understand the condition for which treatment is being offered?

If the patient’s physician deems the individual unfit to make their own decision, they must then seek out a substitute decision maker. If the patient has specified in writing beforehand who should make healthcare decisions for them, this part is easy. If not, it gets a bit tougher to determine who that person should be. Examples of substitute decision makers can include personal care attorneys, a child, parent, spouse, sibling, blood relative or guardian.

Knowing beforehand who will make those critical decisions is certainly helpful, which is why families should specify health care proxies and powers of attorney well before they are needed. Those documents should be kept in a safe place, preferably with the will, in the event they are called upon. With this level of planning, the elderly patient won’t experience a delay in treatment.

On the other side of the coin is the right to refuse treatment. This right to refuse is just as important as the right to consent, and therefore it must meet the same tests as consent. Basically, it must be free and informed. To be free and informed, it must be given voluntarily by the patient and it must be clear that the senior understands the ramifications.

Of course, not all decisions are medical in nature. While there are many strict guidelines in terms of medical consent, things get muddled when it comes to things like romantic relationships and sexual consent. You may have heard reports in the news over the years about dementia patients and their capacity to consent to sex. The lack of clear guidelines regarding this area can present many challenges for caregivers and caregiving communities, as the line becomes blurred when it comes to the desire to protect seniors while at the same time supporting their sexual rights.

Quality of Life

All end-of-life choices and medical decisions are fraught with complex psycho-social components, ramifications, and consequences that impact suffering and the quality of life during hospice, says the American Psychological Association. However, the medical end-of-life decisions can certainly be the most challenging for terminally ill seniors and their caregivers. From a moral and ethical perspective, every decision made during this time should be considered in terms of the relief from suffering and the values and beliefs of the dying individual as much as possible.

Contact Pathways Home Health and Hospice

The decisions faced during end of life care can be confusing, daunting and downright terrifying. Knowing you have a compassionate resource on your side to help guide you through those decisions can be very helpful. Call us at 800-755-7855 or fill out our online form for more information on our hospice services.