Two basic ideas     

a.   Substituted judgement

b.  Best interest for patient

Issues:

o  Bias. Personal interests may interfere with the ability to make the decision that the patient may have wanted.    

o  Unclear what the person may have wanted.

o  Guilt

o  Competing interests

o  Not understanding the medical situation

Benefits

o  Patient Autonomy

o  Lessens burden on decision maker

o   

Alzheimer’s association – support groups and resources.

Work through this concept ahead of time.

Understand what you are supposed to do as the POA.

Hospice and ombudsmen can help families with these decisions.