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Barbara Herlihy (�����ƽ�� ’75), has been with the Santa Clara County Public Guardian’s Office for many years.  She manages estate administration functions for the office and compares the function of the Deputy and Estate Administration staff as similar to that of a detective as they strive to build an understanding of their clients—incapacitated people with no family, friends or appropriate advocates to speak for them.  These clients generally suffer from mental illnesses or they are elderly and often are diagnosed with some form of dementia. These persons are referred to the Public Guardian’s Office because they can no longer make decisions for themselves, or have become victims of some form of elder abuse.  Among other responsibilities, the Public Guardian’s office must determine what kind of medical care they would want if they retained capacity, especially in end-of-life decision-making, as well as what is in their best interest, according to their physicians.

Herlihy has used the training for Public Guardian staff offered by the Markkula Center for Applied Ethics to develop tools to help the office in this work.  In 2017, Public Guardian staff from 16 counties throughout the state of California participated in these workshops, offered in collaboration with the California State Association of Public Administrator/Public Guardian and Public Conservators.

The first thing Herlihy learned is that it’s never too early to begin learning about a client’s wishes.  When clients are referred to the Public Guardian’s office, they “are not typically good historians, and they’re strangers to us,” she says.  “You have to assume they’re as mentally intact as they will ever be, so it’s important to begin right away to get a better picture of their values.”

This is done partly through conversations; even clients who are suffering from dementia may have some capacity to express their wishes.  Public Guardian staff are also taught to interview family and friends. The ethics training, she said, was “so valuable because it helped us learn how to broach these difficult topics.”

As hard as it may be to piece together a picture of the client’s wishes, Herlihy observes that her office has found success in starting the process early and patiently gathering information from sources as varied as instructions for burial or religious preferences, wills, or advance directives. The result makes them feel more confident that these vulnerable people are being included to the greatest extent possible in the important decisions that affect their lives.  As Elizabeth Menkin, the geriatrician who was one of the key presenters for the training, told the group, “It’s not just end of life; it’s quality of life.”

The Ethics Center’s presentation, in conjunction with the legal and medical aspects of the program, offered a sensitive, compassionate approach to ascertaining values and wishes for a very vulnerable population, to make sure that their end-of-life stage provides them with the dignity and respect they deserve.