1. Whose Life is It Anyway? Serving and Supporting At-Risk Seniors with Compassion not Control THE DEMENTIA & ALZHEIMER’S RESOURCE COMMITTEE OF ST. CLAIR COUNTY PRESENTED BY SUSAN WEHRY, M.D., CLINICAL ASSOCIATE PROFESSOR OF PSYCHIATRY UNIVERSITY OF NEW ENGLAND COLLEGE OF MEDICINE

2. Objectives  Discuss self-determination  Distinguish capacity from competency  Have difficult conversations ©S Wehry MD, 2016 Whose Life? 03/03/16 2

3. Cultural traps, stereotypes & family folklore ©S Wehry MD, 2016 Whose Life? 03/03/16 3

4. Basic concepts  Autonomy  Independence  Self-efficacy  Substituted Decision-making ©S Wehry MD, 2016 Whose Life? 03/03/16 4

5. Autonomy  Right to privacy  Right to be responsible  Dignity of risk and the right to fail  Right to be left alone  Right to self-determination ©S Wehry MD, 2016 Whose Life? 03/03/16 5

6. Legal doctrine  “The makers of our Constitution… sought to protect Americans in their beliefs, their thoughts, their emotions and their sensations. They conferred, as against the Government, the right to be left alone -the most comprehensive of rights and the right most valued by civilized men.” ( Brandeis) ©S Wehry MD, 2016 Whose Life? 03/03/16 6

7. Legal doctrine  constitution intended to protect “a great many foolish, unreasonable and even absurd ideas which do not conform…” (Burger) ©S Wehry MD, 2016 Whose Life? 03/03/16 7

8. Autonomy  Not same as independence  Dependence  loss of autonomy  Loss  illness ©S Wehry MD, 2016 Whose Life? 03/03/16 8

9. Independence  I can do it myself  Self-sufficiency  Self-reliance  Freedom  I can do it my way ©S Wehry MD, 2016 Whose Life? 03/03/16 9

10. Self-efficacy “What I do makes a difference” “I’m in charge”  of my destiny “I am responsible”  for my actions ©S Wehry MD, 2016 Whose Life? 03/03/16 10

11. Threats to autonomy Age-Associated Cognitive Changes  Sensory impairment  Attention   Memory Illness, Dependency, Disability  Self-neglect  Failure to thrive  Harm to self  Harm to others ©S Wehry MD, 2016 Whose Life? 03/03/16 11

12. Competency v. Capacity  Competency  a legal concept  Capacity  a clinical concept  the ability to “do” something ©S Wehry MD, 2016 Whose Life? 03/03/16 12

13. Continuum of restrictiveness  P.O.A.  Durable Power  Proxy  Representative Payee  Trust & Trustee ©S Wehry MD, 2016 Whose Life? 03/03/16 13  Conservator  Treatment guardian  Temporary guardian  Limited guardian  Full guardian

14. Difficult questions  What is the goal  Who will do it  Too few guardians  Too few appreciate alternatives  Who really benefits  What are the risks ©S Wehry MD, 2016 Whose Life? 03/03/16 14

15. Risks of guardianships  False sense of security  Permanent labeling  Diverts attention from hard(er) issues  Impact on self-efficacy ©S Wehry MD, 2016 Whose Life? 03/03/16 15

16. Ethical, compassionate caregiving  Strike balance  Utilize principle of substituted judgment  Treat with dignity and respect  Honor choice  Enhance self-efficacy ©S Wehry MD, 2016 Whose Life? 03/03/16 16

17. Enhance Self-Efficacy  Advance planning  Palliation  End of life care  The Five Questions  Opportunities for control  Share problem-solving  Physical exercise  Meaningful responsibility ©S Wehry MD, 2016 Whose Life? 03/03/16 17

18. Individual Stories QUESTIONS, COMMENTS AND SHARED PROBLEM- SOLVING ©S Wehry MD, 2016 Whose Life? 03/03/16 18

19. Thank You FOR BEING HERE FOR PARTICIPATING FOR ALL YOU DO More Questions? Comments? Please contact meswehrymd@mac.comswehrymd@mac.com Visit my websitewww.susanwehrymd.comwww.susanwehrymd.com Or join me on Twitter: @CommishVT12 @beingwithaging #changingaging #Oasis2