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Discussions with your Doctor about your Future Wishes

There are days in my clinic where I seem to be having the same conversation over and over—but with a different patient and different family. I have often thought that a model of care I once heard a presentation about might be worth doing—having the equivalent of a group therapy, but with a number of my patients and their families to discuss the common problems in aging and cognitive function. The majority of those I see in my office practice these days are elders living with some degree of cognitive impairment—ranging from the mildest of forms, to those with quite severe impairment so that the label of dementia is appropriate. Whether the condition is due to Alzheimer's disease, blood vessel (vascular) disease or as is the case in most that I see, a combination does not matter that much in terms of what it means for patients and their families.

The points I try to make to those who come to me is that at this point there are no cures, there are medications that may control symptoms to some degree but the essence of life is to keep living at whatever level one can. In addition the importance of planning for the future is clear and should be addressed by patients and encouraged by family members.

Of the important parts of the conversation that I focus on are what the person would prefer should they no longer be able to make important decisions again. Those are very important conversations and have to be emphasized time and again. Even though writing a living will or as is the correct term an advance directive, is not legally necessary, it is sometimes helpful to have one to eliminate and conflicts from those acting on your behalf as to what you would have really wanted in the end-of-situation.

Sometimes it isn't enough to write down your wishes, but to make sure those you have entrusted with carrying out your wishes can be trusted with that duty—that is not always an easy task for caring family members. If you cannot be sure of that commitment it may be worth looking for someone to appoint who is not a family member but rather a close and trusted friend—it might lead to hard feelings from your family—but that is the way the law works and it is also part of human nature.

Have the conversations including with your physicians, your family members and if necessary your closest friends so that when the time comes, you can rest assured that your wishes, your values and your preferences will be respected.