Guardianship and End-of-Life Decision Making: A Podcast with Andy Cohen and Liz Dzeng
episode
GeriPal - A Geriatrics and Palliative Medicine Podcast
46 min
4 speakers
8 chapters
transcribed 6 hours ago
Transcript
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Transcript generated automatically by AI and may contain errors.
What is the overall focus of this episode on guardianship and end‑of‑life care?
The JerryPow podcast is brought to you by Archstone Foundation, preparing society and meeting the needs of an aging population. And now, here are your hosts.
Welcome to the JerryPout Podcast. This is Eric Quadera. This is Alex Smith. And Alex, who do we have with us today?
Today we're welcoming back to the podcast, Andrew Cohen, who's assistant professor of geriatrics at Yale and was on one of our early, earlier episodes. Welcome back to the JerryPel podcast, Andrew.
It's a pleasure to be back.
And who else I see
somebody else?
Yes. We're welcoming back to our podcast, Liz Zhang, who is assistant professor of hospital medicine at UCSF. Welcome back to the Jerry Pell podcast, Liz.
Thank you. It's great to be here.
So we're gonna be starting off this discussion on guardianship and end-of-life care. Um, does it change anything if people have guardians? I I think I have a guess, but I may be wrong. But before we go into that topic, we always have a song request. Andrew, do you have a song request for Alex?
Yes, I do. Liz and I put our heads together about this and we settled on better things. So that was it's originally by the Kinks. Um, but I there have been a couple of covers, including one by Dar Williams, that we both really liked.
And I like that cover too, but I cannot emulate Dar Williams, so I'm gonna do the Pearl Jamish version. Um without the Pearl Jan backing band. But but tell us why you chose better things. Uh I mean things are going great now, right? Why why
Yeah. Well, we were looking ahead towards what's gonna be a really uh difficult winter and And thinking about about twenty twenty one. And about how uh things are things are gonna be better sometime next year.
Mm-hmm. Great.
Here's wishing you the blueest sky. And hoping that something better comes tomorrow Hoping all the verse is rhyme and the very best of forest is too. Follow all the doubt and sadness, I know better things are on their way. It's really good to see you rocking out and having fun, living like you just begun. Accept your life and what it brings. I hope tomorrow you'll find better things. I hope
tomorrow you'll find better things.
Awesome. Thank you, Alex. Fun song. Thanks. Andrew, I'm gonna start off with you. So how did you get interested in the topic of guardianship and you know, whether or not that has anything to do with high intensity end of life treatment?
Yeah, so there were really two different reasons. Um One of them is that when I started doing my geriatrics fellowship. Um, I realized I was seeing people with guardians or people who needed guardians fairly often and was for the first time filling out petitions to the probate court. And thinking about this system. Pretty often. And In the hospital had a few experiences uh Frankly, negative experiences with guardians where I couldn't reach them or I could reach them, but uh they didn't make the decision that I thought was clinically appropriate. So I was interested in this uh phenomenon and found out pretty quickly that it hadn't been studied empirically um for reasons I can get into.
Mm-hmm.
The second reason is that I'm interested more broadly in in in surrogate decision making and And this idea that We intuitively expect a family member to be available and to know how to be a good surrogate decision maker if some someone needs one. And uh guardianship was a Kind of an interesting model for thinking about surrogate decision making, since in many cases, guardians don't know the person before they have to start making decisions for them. So it can be difficult or impossible for them to try to imagine what the person wanted. And also because unlike uh family members, uh guardians, at least in some states, are have laws that direct them to use a specific standard. So the dis so the decision making process for guardians is both kind of more
explicit and in a certain way less complicated because they didn't know the person ahead of time.
How did Andy Cohen become interested in studying guardianship and high‑intensity treatments?
So trying to imagine what they wanted is is usually not possible.
Yeah, and I can we just backing up for a sec, what like what is a guardian?
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Chapters
8 chapters
1
What is the overall focus of this episode on guardianship and end‑of‑life care?
0:01–5:05
2
How did Andy Cohen become interested in studying guardianship and high‑intensity treatments?
5:05–10:03
3
What exactly is a legal guardian or conservator and how do their roles differ?
10:03–15:37
4
What were the surprising results of the JAGS study on veterans with dementia and guardians?
15:37–21:39
5
Why might patients with guardians receive similar levels of intensive care as those with family surrogates?
21:39–29:36
6
How do substituted judgment and best‑interest standards shape decision‑making for dementia patients?
29:36–35:54
7
What are the strengths and limitations of dementia‑specific advance directives?
35:54–41:33
8
How can institutional culture and broader societal norms be changed to improve end‑of‑life care?
41:33–46:53
Speakers
4 identifiedMore from GeriPal - A Geriatrics and Palliative Medicine Podcast
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