A recent news article on the famous DJ Casey Kasem and the fight about his care illustrates a problem that is likely to become more and more familiar as the population ages and caretaking becomes more widespread. While not all family feuds of this type will descend to raw meat throwing, emotions can get pretty strong.
There is much confusion in the mind of most people about the most appropriate way to care for loved ones approaching the end of life. Remember the fears about "government death panels" when the Affordable Care Act was being debated? The goal there was to have doctors encourage their patients to think about the end-of-life and what their wishes would be regarding the type of medical care they would want their families and doctors to pursue if they were no longer able to competently make decisions.
These are not conversations that anyone loves to have. We don't enjoy thinking about our demise. Planning ahead and figuring out what we would want can, however, avoid unfortunate problems down the road.
Dementia: All Too Common
We think dementia or senility is easy to detect but it first emerges in ways that look more like depression, stubbornness or anger. As people's thinking deteriorates, their ability to make good decision also greatly deteriorates. When a loved one begins to act against their own interests, we may rationalize it as stubbornness or giving up when, often, it is just that the person is unable to tell the ramifications of their choices. By the time it is obvious that the person is no longer capable of thinking well, they may have lost opportunities to protect their health.
Often, by the time relatives take over decision making and care of a deteriorated family member, the situation is much more complicated and stressful than if they had been able to be involved earlier. If there are multiple family members involved: spouses, children, siblings, each may have a different idea of what the best plan would be.How do those differences get resolved? Sometimes harmoniously-often not.
Money Complicates Everything
When the aging person has assets that caretakers will inherit, the situation gets even more complicated. What kind of care and at what cost will be chosen? Self-interest enters and adds another layer to the plans put forward. Court battles over Power Of Attorney and Health Care Surrogacy (the legal right to make medical decisions for an impaired person) can emerge and courts are poorly equipped to make complex evaluations and decisions in these matters.
Family Members At War
Many families have internal feuds and having to make complex health decisions when the family members haven't worked well together before is quite challenging. We all see things from our own perspective. Family members living with or living close to the ailing person may have a completely different view of things than those living farther away and not involved in day-to-day care. Not all parents are wonderful, loving people. How are decisions made when Mom or Dad wasn’t really that great a person in the past.
Viewed in this context, the extreme incidents reported in the Casey Kasem case are not too surprising. Expect to hear more "celebrity finales" in the same way celebrity divorces and breakups are covered today.
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