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January 2, 2018 – Hemlock Society of San Diego Meeting

Amy Abrams, MSW, MPH, Education & Outreach Manager, Alzheimer’s San Diego
Lisa Heikoff, M.D., geriatrician, Kaiser Permanente, Community Advisory Board of Alzheimer’s San Diego
Hannah Wilder, Episcopal priest, in training. Her mother-in-law has advanced dementia. ”
Bob Uslander, M.D., Medical Director and Founder, Integrated MD Care.

This program on end-of-life options for those with Alzheimer’s or dementia talks about the importance of advance directives, POLST and do-not-resuscitate (DNR) forms. We learn most surgeons won’t allow DNR during the peri-operative period.

Hanna Wilder relates a heart-wrenching story about her mother-in-law, who has Alzheimer’s. The story tells how the daughter (healthcare proxy) was pressured (guilt tripped) by a surgeon to perform a surgery the daughter was reluctant to approve of due to her mother’s advance care directive. It illustrates how easily health care proxies can be pressured by the medical establishment to go against their instinct to say no.

Lisa Heikoff, M.D., geriatrician, stresses the importance of disclosing an Alzheimer’s diagnosis in the early stages. She relates the surprising and major life change her brother-in-law made in the face of his early Alzheimer’s diagnosis. She advises us that all of our local healthcare facilities are required to have bioethics committees. You can request a consultation if you are uncomfortable with a provider’s recommendation. She also answers a question regarding decisional capacity. There are different levels depending on the complexity of the issue. She advises when there are questions about a person’s decisional capacity after a diagnosis has been established, prior to them signing an important document, you should have them evaluated by an experienced neurologist, geriatrician or psychiatrist; one who has experience in determining decisional capacity. She also reminds us that institutions are required by regulations to feed a patient; making the Voluntarily Stopping Eating and Drinking (VSED) method difficult to pull off if one is in an institution and cannot remember things.

Amy Abrams, MSW, MPH, tells us about the many educational programs the San Diego Alzheimer’s Association has for patients and caregivers; and the distressing fact that approximately 50% of Alzheimer’s patients have anosognosia, which is a complete unawareness of their illness.

Dr. Bob Uslander reminds us that we have the right to refuse medical treatment and relates a strategy to avoid unwanted trips to the emergency room when an elderly person is reaching the end-of-life stage.

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