REVIEWED BY JANICE FISHER, RNC
The Caregiver's Path To Compassionate Decision Making: Making Choices For Those Who Can't
By Viki Kind, M.A.
Greenleaf Book Group Press, 2010
216 pages, $14.95
President and Chief Executive Officer of Associated Banc-Corp Robert C. Gallagher once said, "Change is inevitable — except from a vending machine." Although this quotation is silly, it highlights a reality we don't often think about: bodily change. If we are in our 50s, we somehow still imagine we are in our 30s. If we are in our 60s, we still push our bodies and expect that they will act as they did when we were in our 40s. No matter what age we are, we have a hard time accepting the changes that happen to us as we age.
Aging brings chances of stroke, heart attack and other medical emergencies that can render individuals unable to make decisions for themselves. What plans have you made should a life-changing event happen to you or your loved ones? Have you expressed your wishes to others? Would you know how to make the right decisions for someone if you were designated to do so?
So very appropriately titled, the book The Caregiver's Path to Compassionate Decision Making not only answers these questions but also gently guides the reader through the entire process of decision-making in nearly any medical or end-of-life situation. Viki Kind accomplishes a remarkable task by presenting both sensitive and clinical material in an accessible way. She describes use of strategies, tools and questions to determine how to make the right decisions for each individual. Kind's credentials as a clinical bioethicist, medical educator and hospice volunteer qualify her as an expert on this topic. In addition, she is able to connect and bolster her credibility with the reader by weaving her own personal experiences throughout the book.
This book is a guide for individuals who want to become more informed and who want to make arrangements before life-changing events occur. In my experience as a nurse, I have found that many people do not like to think about, let alone talk about, death and dying. The author guides the reader through a step-by-step process of decision-making for those who can't. This work is important because not only does Kind give concrete clinical advice, she also is pastoral in her approach.
Kind uses five core questions to frame the text. For instance, Question 1: "Does the individual have the ability to make his or her own decision? Does he or she have decisional capacity?" Question 2: "If the person is not able to speak for himself or herself, how long will it last?" These questions, in turn, challenge the reader to identify what is known about the person so that the decisions being made will mirror the person's wishes. In addition to these questions, four strategies are identified which assist a caregiver through this process as well as provide training in using moral, ethical and legal parameters.
Kind develops a "Five Core Question Flowchart" as a road map for the decision-maker to follow. It uses real-life situations to illustrate the appropriate use of these tools. This process may seem technical or clinical, but it also integrates religious, spiritual, financial, cultural and personal values to enhance quality of life for the person who is unable to make his or her own decisions.
The "End of Life" section provides specific medical information concerning the process of dying. Kind explains in detail the difference between palliative care, comfort care and hospice care as well as medical decisions related to cardiopulmonary resuscitation (CPR) and Do Not Resuscitate (DNR). These are especially helpful to those outside of the clinical field. The vocabulary involved at the end of life alone can be overwhelming.
"Did I Matter?" explores a universal question that people ask when they are dying. Kind beautifully describes an extraordinary ritual that caregivers can perform for the person who is dying that brings comforting closure.
The only caveat I have is in regard to one opinion Kind expresses. She states that more and more people are being abandoned in long-term care facilities, thus "nobody takes the time to make sure good decisions are being made." My experience is that even if families can't or won't advocate for the resident, our facility social workers, nurses and chaplains as well as the state ombudsman all work very hard to speak for them and to protect them.
As a registered nurse with 32 years of acute care and long-term care experience, I have never come across a book that incorporates all the questions that need to be contemplated by caregivers. Kind includes "tool-box resources" as well as other guides, excellent resources for anyone faced with difficult medical decisions.
JANICE FISHER is administrator at Namaste Alzheimer Center, Colorado Springs, Colo.