Blog Harvey A. Friedman Center for Aging

Putting your words in someone else’s mouth: A good, necessary thing

Written by Brian Carpenter, PhD, professor in the Department of Psychology in Arts & Sciences

“What do you want to have for dinner?”
“Should we go to that art festival this weekend?”
“Does this shirt make me look weird?”

We ask our family and friends for their opinion and input all the time. Sometimes we ask about relatively minor things. Sometimes we ask about more major things.

“Should I move to New York?”
“Do you think this guy is right for me?”
“Can we afford to buy this car?”

That happens in health care situations too, when we’re faced with complicated choices that could have serious consequences.

“Should I take this medicine?”
“Do you think surgery is worth the risks?”
“Would you trust this doctor?”

family filing out legal paperwork

We ask people for their input because talking through a situation can help us see pros and cons we haven’t thought of ourselves. Family and friends might have expertise or experience or knowledge that teach us something and help us make better decisions. We also reach out to people whose judgment we trust. All this feedback is helpful and good.

But there are times in many of our lives when we’ll need more than just input from friends and family. There are times when friends and family will have to make decisions for us, when we can’t make them for ourselves. After a stroke or head injury, for instance, we may not be able to tell people what kind of medical care we want, though maybe for just a brief period. Or in the case of Alzheimer’s disease or other progressive illness, we may gradually and permanently lose the power to express our preferences.

Any person, at any age, has the potential to be in a serious medical situation when they need someone else to make decisions for them. If that happens, it’s important that there’s someone who knows what we want and can tell others. Have you thought about who that person might be for you? And have you talked with them about it?

If you’re like most people, probably not. But there are several ways you can be better prepared, and it’s your responsibility to start talking.

Each of you has the important responsibility right now to identify a person who can speak for you, before you’re in a crisis, when you have time to make sure they’re comfortable with that role and really know what you want.

One option is to fill out an “advance directive,” also known as a “living will,” which allow you to document what kinds of medical treatments you do and don’t want, in case you can’t state your own wishes. (You complete it in “advance,” and it “directs” people to do what you want.) An organization called Aging with Dignity has created a form called The Five Wishes that guides people through questions to help them record their medical preferences. Most state governments also provide free resources and forms for doing the same thing. For example, the Missouri Attorney General’s Office offers a free booklet called Life Choices (pdf).

Maybe even more important than the advance directive is a legal document called a Durable Power of Attorney. That allows you to identify a person (or people) who you want to make decisions for you, if you can’t express your own choices. It’s probably a good idea to have both documents – Advance Directive and Durable Power of Attorney – filled out and distributed to your family and health-care providers. But some experts say the durable power of attorney is more important.

That’s because even a very detailed advance directive can’t predict every health care situation you might find yourself in. A power of attorney, on the other hand, can make decisions for you even if you haven’t talked with them about every possible scenario. The power of attorney makes decisions based on what they know about your general values or about preferences you’ve expressed about similar situations. What this means, though, is that you need to pick that person carefully.

Here are some questions to consider when identifying who might be a good power of attorney for you:

  • Do I trust this person’s judgment? In other words, can they understand complicated information, weigh pros and cons, and make decisions in a rational way, not clouded by emotions?
  • Does this person know me well? Do we have enough history together that they really know what’s important to me in life? Can they figure out what I would want, even if we haven’t talked about every specific situation and possibility?
  • Can this person see the difference between what I want and what they might want for themselves if they were in my shoes, and still make a choice that’s consistent with what I want?
  • Does this person have the strength to choose what I would want, even in the face of potentially great stress and pressure from other people to make a different choice? Maybe even close family who are arguing for a different choice?
  • Is this person willing to take on this responsibility? Do they know what they’re signing up for and do I have their permission?

You should pick someone who knows what makes life meaningful to you and how you define quality of life. You should pick someone who is familiar with your philosophy about life and any religious or spiritual beliefs that guide you. And you should pick someone who can articulate what you would want, if you could speak for yourself, and stay firm in that belief even if someone else disagrees.

Each of you has the important responsibility right now to identify a person who can speak for you, before you’re in a crisis, when you have time to make sure they’re comfortable with that role and really know what you want. Not everyone in your life is going to be able to do that, but it’s your responsibility to find the person who can. So start talking!