Search Results

Seventy percent of Americans age 60 or over requiring decisions about treatment in the final days of life lack capacity to make these decisions. The biggest life-and-death decisions of their lives—literally—had to be made by someone else. Loved ones hold life and death in their hands because constitutional rights of autonomy and self-determination are extended by law to surrogates authorized to make medical decisions on patients’ behalf when the latter cannot. Yet despite their critical role, we know remarkably little about these surrogates, the decision-making process they follow, the choices they make, and the challenges they face. Drawing on the stories of two families—one demanding that physicians “just pull the damn plug” and another that life support be continued despite brain death—this chapter introduces the surrogates who determine the trajectories of life’s end. Systematic observations in two intensive care units, day after day, for more than two years offer a window on how these end-of-life trajectories take shape and change course. The chapter concludes by showing how lessons from the intensive care units are relevant to future patients and their loved ones as well as physicians, nurses, chaplains, social workers, lawyers, scholars, bioethicists, and policy makers.

As we have discussed in previous chapters, it is very important for people with psychosis and their family members to learn about psychosis and effective treatments. This sort of learning is an important step towards recovery and preventing a relapse. However, seeking information to better understand psychosis can be frustrating at times. The amount of information received from mental health professionals and other sources can be overwhelming. However, aside from this book, very few books focus on first-episode psychosis. When searching the Internet, it is difficult at times to tell the difference between Web sites with correct and helpful information from those that contain opinions and confusing information. This chapter describes the benefits of educating yourself about psychosis and then describes different resources that are available. As discussed in Chapter 7 on Psychosocial Treatments for Early Psychosis, psychoeducation is a type of education that focuses on the topic of mental illnesses. The goal of psychoeducation is to help individuals with a mental illness, and their family members, better understand the illness. If a person understands his or her illness, then he or she will be able to deal with it more successfully. Psychoeducation, for both patients and their families, is an effective form of treatment in itself and an important step in preventing relapse and hospitalization. Research has shown that those who receive psychoeducation are less likely to have a relapse and enter the hospital compared to those who do not receive psychoeducation. The patient’s mental health professional is one of the best sources of information. Do not be afraid to ask him or her to explain more if some piece of information is unclear. Another good idea is to bring a list of questions with you when you meet with the mental health professional to make sure that you leave the appointment with all of your questions answered. Asking questions and getting answers helps you become confident that you understand the next steps. Worksheets provided in Chapters 2 and 9 will help you keep track of information that may be important to share with the mental health professional.