Plan now to plan ahead for the right substitute decision maker

Choose the right substitute decision makers (SDM) now.

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 SDM that for example the parent "would not want any heroics" if they develop a terminal illness. The reality is that 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 the SDM can honestly and emotionally carry out your loved one's wishes;

2) agree on those life-prolonging interventions that for sure your aging loved ones would not want–such as a permanent feeding tube:

3) make sure in addition to writing a document, that there is a conversation with your loved one;

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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