Focusing on Freedom

During Passover, we celebrate freedom. We tell the story of the exodus from Egypt and we are reminded, once again, about the value of freedom—what it means to us as a people and what it means to us as individuals. Being free, being independent, making our own choices in life are priorities for all of us and that message is reinforced by the words we read during our Passover Seder.

Yet when we look at the lives of older adults and think about freedom, we find that, for many, the freedoms have not only diminished but they have all but disappeared. The freedom to choose our living situation, to decide what we are going to do and when, the ability to drive our own car and determine our own direction—so much of that seems to vanish with the onset of age.

Of course we know that disease and disability play a role. Someone who experiences visual impairments may not be able to drive safely. An individual with dementia may not be safe in the home they have had and all the rest. As family members, and as care providers, our focus is—as it should be—on health and safety first and foremost.

Yet we must never forget that each of us is a whole person, regardless of the impact of aging on us. We are not a one dimensional, labeled “disease,” we are a full human whose needs are not just body but also mind and spirit. This is what we must always remember as health care providers and it is also what we must educate our community, and family members, to understand.

One of the most important ways for us to show that we value the person as a whole is to give choices. We cannot know what someone else would want, what they would decide for themselves, unless we ask them. Some of these choices are “big picture” choices, understanding what kinds of medical interventions a person would want, defining end of life preferences for care and treatment, deciding what to do in the event of “what if.”

When someone can speak for themselves, we need to listen to and respect their choices. I know of families who have overridden their loved one’s wishes for good reasons. Unfortunately, all of those reasons were the family’s reasons and not the individual’s. And often the older adult gives in to the choices of their family, not wanting to upset them. Yet the decisions are not the ones that they made or would make. While this is often done with love, it does not allow the older adult the choices to which they, as individuals, are entitled.

What happens when disease or disability prevents them from expressing their wishes? Living wills and advanced directives have been around for a long time and the newer forms are called POLST (or MOLST in other States), referring to Physician Orders for Life Sustaining Treatment. More important than any form, however, is having those discussions with your loved ones while they are still able, understanding what they value and asking them what matters to them. Their choices may surprise us, they may not be the ones that we would make but when we know them, we are, I think, obligated to respect them.

Freedom of choice, freedom to decide—age should not prevent us from expressing our own needs and opinions. We owe it to ourselves and our loved ones to discuss those choices and then honor the choices that they make.