As a geriatric care manager, in the early part of my journey with senior adults and their families, I ask about advanced directives: a living will, power of attorney and a health care proxy. There will be one of three responses: 1. No, my mother refuses to talk about these documents. 2. We are planning to go to an attorney or 3. Yes, there has been a designated POA and health care agent.

If you fall into the number three category, it may be with relief that you have these documents in place. As the health care agent, you have had the “discussion” and understand the wishes of the person you will represent. You are certain that you can march forward through the complexities of end of life decision making. Yet for some, when the time arrives, that confidence becomes clouded by doubt. It’s not unusual. Such was the case for Lorraine, Anne’s daughter.

Anne, my client of nearly five years, confided in me with weekly regularity that she wanted to die. She knew she was losing her memory and was humiliated by what was happening. Other indignities followed. An extremely anxious person, the only comfort she took was that Lorraine knew her wishes and would do right by her.

Lorraine did not visit her mother with any frequency despite living just over the Westchester County border in Connecticut, a thirty-minute trip. Watching these meager visits and equally few telephone calls, I was sure that when Anne’s doctor called Lorraine to suggest hospice care, she would readily agree. To my surprise, Lorraine would not acquiesce. She acknowledged to me that she knew what she was supposed to do as her mother’s agent. The problem was she could not bring herself to make those final decisions about stopping advanced medical treatment, nutrition, and hydration. “Who am I to make those decisions?” she said to me. I wondered, was it unspoken hope or unease?

Anne lingered with time becoming the final decision-maker. In the days before Anne’s death, I said to Lorraine, with no suggestion of judgment, that she would carry with her whatever decision she made. I recognized that those who generously take on the role of health care agent do so with a full heart. But sometimes, good intentions can be superseded by last-minute questioning. Doubt fogs the road we thought we could readily take.