The Downside of Power

Ok I’ll admit it: I like power. I like to have it, I like to exercise it, I like it a whole lot. And I even like the responsibility that comes with it.

Sometimes it gets me places I didn’t think I’d ever be going.

Take powers of attorney, for instance. I’ve had a few in my life, especially from relatives who trusted my judgment in an emergency. That’s usually when good judgment is needed, so that the emergency can be addressed without a detailed think-through of potential consequences and if-thens and maybe-buts.

But now I have an emergency of my own, and it has a lot of moving parts. I need to construct a whole end-of-life scenario for someone dear who can’t.

As you get down into the details of something as delicate as this, there are tough decisions to be made. Sometimes basic values apply cleanly. Sometimes they don’t. My usual approach to this kind of ambiguity is to look for situations that are somewhat similar and use them to identify an answer.

That’s how I got to thinking about how end of life is very similar to end of job – also known as termination, downsizing, and outplacement. Having made this connection, three guiding principles came into view. They are:

  1. Maintain a ‘least restrictive’ environment.

In the healthcare world (particularly mental health) this means allowing the person the latitude to do what they need or want to do, as long as it doesn’t compromise their own, or other people’s, safety. For the end of lifer with a cognition-limiting diagnosis, it means no tying them down or stopping them from eating as much ice cream as they want.

Comparably, in the employment world, it means that when you’ve decided to fire someone, don’t pile on a terrible evaluation or otherwise spirit-damaging experience on the eve of their impending separation.

  1. Make the transition as painless as possible.

In the healthcare world, I am talking about paying attention and taking action to ease pain, boredom, or distress, in whatever manner that drugs, comfort accommodations, and/or companionship will be effective. Because anything that takes the mind off doom dwelling, at least for a little while, is a blessing.

In the employment world, I’m saying that when people are on the way out, even if no one really likes them, please provide the courtesy of a farewell lunch or cake and/or group card…whatever. It feels lousy enough to have been cut from the team, especially when you enjoyed and appreciated the job. Don’t compound the pain by omitting the niceties.

  1. Avoid false hope, but be sympathetic.

In the health world, this refers to the DNR (Do Not Resuscitate) order. Helpful staff people usually want those who have power of attorney over someone’s final days to sign the DNR yesterday. Any reluctance to do so is generally met with an air of suspicion. (Fear of liability is apparently as strong a motivator to action as, say, a tiger loose in the lobby.) Since this was the most difficult principle for me to define, I tried out a lot of scenarios from other fields. Again, comparison to the world of work was the most enlightening.

In employment world, termination is very much like a DNR. There’s an order stating that a person or persons have to go, and usually the person who carries out the order isn’t the one who made the decision in the first place. (Think about that for a moment. The power of attorney holder is not the one making the decision that the person will be let go. That decision takes place at a higher level, so to speak.) Primarily for this reason, it’s important for the bearer of bad news to depersonalize the whole process. Sad to say, many do a great job of the depersonalization part, but of the rest, not so much.

What if, instead, we made it clear that at least one person in the room really wanted the soon-to-be-departed to stay? In the health world, that would involve an effort to connect at the very end, as a sort of social resuscitation. In the employment world, it could be as simple as adding one small word of regret by the terminator.

Will you ‘love people out’ or will you just leave them behind?

You have the power to choose.

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