Americans are living longer, and longer life spans means that questions are often raised about the elderly individual’s ability to make decisions for themselves about their medical, financial, and legal lives. Statistics show that more than 50% of people over the age of 85 suffer from some form of dementia. Whether or not an individual fully understands the consequences of their decisions and actions is essential to determining their capacity, and only a psychiatrist can do that. But civil capacity is often confusing for both medical and legal professionals.

Forensic psychiatrists like Dr. David Salvage, often address the issue of capacity within the family dynamic because of the aging population. Cases often open when an individual waits too long to create a will, develop a living will or take care of other aspects of their lives before their capacities are called into question. Dr. Salvage has seen heard first-hand accounts of patients voicing their wishes to their families. But doctors can not follow wishes that are delivered via third party. But this tragic situation can be avoided if the individual has set up a living will in advance.

Dr. Savage recommends setting up a will, a living will or a healthcare proxy as soon as possible.

“Now is the time to talk this over with a lawyer and your doctor,” explains Dr. Salvage, “so your wishes will be completely clear for everyone. Especially you.”

There are some cases, though, when a patient cannot clearly demonstrate their capacity, that the principles of medical ethics requires that doctors honor the refusal, except when acute emergency care is required or if the treatment could be life-saving.

For example, if an elderly with advancing dementia is diagnosed with a terminal illness but refuses treatment even without truly understanding her treatment options, then passive refusal may be honored. Even if the disease is fatal over an extended period of time, it is not acutely life threatening.

By contrast, if an 80-year-old man is brought to the ER with signs of an acute heart attack, and he is unable to voice his preference but physically fights the medical staff when they try to treat him, then he will still be treated. Without advanced directives, his case is considered an acute emergency whose outcome, his survival, is clear.

With a clear and advanced guide to follow, patients and families can be assured that their wishes will be honored by medical and legal staff. Contact an expert in civil capacity like Dr. David Salvage to address your questions and options.

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