Strategic Decisions Require Joint Consent

For a 94-year-old, the complex topic of 'Strategic Decisions Require Joint Consent' shifts from a corporate context to one of deeply personal significance, primarily concerning their health, care, living arrangements, and legacy. At this age, the 'non-managerial owners' who retain strategic authority are often the elders themselves, whose autonomy and wishes are paramount, while 'joint consent' is sought with family, caregivers, and medical/legal professionals.

Our selection, 'Five Wishes' by Aging with Dignity, is globally recognized as the best-in-class tool for this purpose because it directly empowers the 94-year-old to articulate their strategic input. It translates abstract 'strategic decisions' into concrete, actionable wishes across five critical areas: the person I want to make care decisions for me, the kind of medical treatment I want or don't want, how comfortable I want to be, how I want people to treat me, and what I want my loved ones to know. Its language is accessible, compassionate, and focuses on the individual's values, rather than just medical procedures.

This tool supports our core developmental principles for this age:

1. Cognitive Accessibility & Support for Complex Information Processing: The simple, question-based format and clear language make it easy to understand and complete, even with potential cognitive decline, allowing for reflection without being overwhelming.
2. Empowerment and Voice Preservation: It ensures the elder's voice is central, allowing them to explicitly state their preferences, thereby preserving their strategic authority and autonomy.
3. Facilitation of Intergenerational Dialogue: Completing and sharing 'Five Wishes' creates a structured framework for essential, empathetic conversations with family and caregivers, ensuring mutual understanding and fostering genuine 'joint consent' on crucial life decisions.

Implementation Protocol:

1. Gentle Introduction: Present 'Five Wishes' as a powerful tool for the individual to share their wisdom and ensure their preferences are known and respected, not as a daunting task about end-of-life. Emphasize it's about living well on their terms.
2. Facilitated Completion: A trusted, patient, and neutral family member, friend, or professional (e.g., social worker, chaplain) should offer to sit with the individual over several sessions (as needed) to read the questions aloud, transcribe answers, and clarify any ambiguities. This ensures the elder's voice is accurately captured without pressure.
3. Review and Personalization: Once drafted, review the document together to ensure it truly reflects their current wishes and values. Emphasize that it can be updated at any time.
4. The 'Joint Consent' Conversation: Arrange a dedicated, calm meeting with key family members and, if applicable, medical power of attorney or legal representative. The elder, with support, presents their completed 'Five Wishes.' The purpose of this meeting is for 'joint consent' – that is, for all parties to understand, acknowledge, and commit to honoring the elder's stated strategic decisions. This is not a negotiation, but a collaborative agreement to uphold their autonomy.
5. Formalization and Distribution: Once understanding and agreement are reached, the document should be signed and witnessed according to local legal requirements. Copies are then distributed to the individual, family members, primary care physician, relevant specialists, and legal counsel. Store originals securely. Revisit and update annually or after significant health changes to ensure ongoing relevance and 'joint consent' on evolving strategic decisions.