Co-decision-maker and Designated healthcare representative

Making an advance healthcare directive when having a co-decision-maker for other decisions

Maura is an older woman with early onset Alzheimer’s disease. Still living at home, Maura’s main problem is her memory: she commonly forgets what day of the week it is, who her husband is, and what she is supposed to be doing. On other days, however, she seems to remember almost everything.

Maura owns a farm her parents had left to her, and she decides that she wants to sell it. She believes, however, that the farm is far more extensive than it is, and she cannot be dissuaded from this position by her husband or her solicitor. Aware of her early dementia, Maura suddenly becomes tearful at one meeting with the solicitor and finally admitted that she is unclear about the extent of the property.

Following some discussion, it becomes apparent that, even with considerable assistance, Maura is unable to make this decision on her own, and she decides to put a co-decision-making agreement into place to support her in this and other financial decisions. She asks her son Michael, who lives close by, if he will be her co-decision-maker and he agrees to this. Together they make decisions regarding the sale of the farm.

A few months later, Maura decides to take steps regarding future treatment for her Alzheimer’s disease in the event that she loses capacity to decide about this matter. She writes an advance healthcare directive outlining her wishes clearly and appoints her husband as her designated healthcare representative.

Despite her Alzheimer’s disease, Maura understands the information relevant to this decision and can retain it for sustained periods, weighing up the relevant factors, and communicating her decision clearly in her advance healthcare directive.

Comment: This vignette shows that a person may still have the capacity to make an advance healthcare directive even if they require the support of a co-decision-maker in relation to other decisions. 

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