Health Care Decisions: Black and White vs. Gray Areas

Black and white scenarios are simple. They usually involve just one decision and there is some predictability in their outcome.

Gray areas, on the other hand, involve several, often interconnected decisions and vary based on the preferences of the people involved as well as their particular circumstances. These scenarios are often unpredictable and can be confusing or stressful. They may, at times, even feel unfair.

Consider the case of my client, Jim. He was approaching 65, planned to remain working and had health insurance through his current employer. His wife, also 65, was retired and had access to retiree medical benefits for both herself and her spouse. Jim had to choose among the following options:

  • Stay on his employer-sponsored plan
  • Access traditional Medicare and its suite of associated products
  • Revert to his wife’s retiree medical coverage

He was confused.

Another client was diagnosed with a blocked cardiac artery. He also had three options presented to him:

  • Take several cardiac medications and be closely monitored for symptoms
  • Have a cardiac catheterization procedure that could involve insertion of a stent to open the blocked artery
  • Consider the need for open heart cardiac surgery as a possibility if stenting was not appropriate

He wasn’t sure what to do either.

A third client, Barbara, was caring for her spouse at home. He had Alzheimer’s Dementia that had now progressed to the point where caring for him alone was becoming unsafe for Barbara and her husband. Her options were as follows:

  • Share caregiving responsibilities with her children
  • Hire private help in the home to assist her
  • Research and possibly move her husband to a Memory Unit in an Assisted Living facility

All of these options posed dilemmas for her.

How to sort through the choices available

Clearly, and in all three of these examples, the decisions to be made are in that murky gray area of “it depends.” How then, does one decide? Here are a few suggestions to help you and your loved ones through the process:

  • Gather as much information as possible

    For the gentleman choosing his insurance, a spreadsheet that compared benefits and the cost of each option helped him decide.For the man with cardiac disease, a long discussion with his cardiologist, during which she outlined the risks and benefits of each choice based on the scientific literature, was helpful.For the woman caring for her husband, a discussion with her children about their availability to help, as well as researching the cost of in-home care or a move to a Memory Unit was invaluable.

  • Don’t go it alone

    These are big, potentially life-altering decisions; there is no reason you need to make them alone. As I’ve mentioned in previous newsletters, there is tremendous value in having a Care Partner who can attend physician appointments, acting as another set of ears, a scribe, and a helper.A Care Partner is equally useful within these gray areas of decision making. They can help by:
    • Listening
    • Helping you to identify all the options available
    • Helping you think through the implications of each decision
    • Helping you reach a decision you can live with
  • Superimpose your preferences on the options availableThe man facing an insurance decision liked his employer-sponsored plan and was not looking forward to a change that might impose an administrative burden on him.The man with the artery blockage wanted to resume all his activities and did not want to be held back by symptoms of angina that might occur.Barbara had a preference for caring for her husband at home.

  • Listen to your intuitionOnce you’ve gathered information from as many sources as you feel comfortable with, listen to your gut about what the best decision – for you – may be. We’re all different; intuition is about acquiring knowledge and then making decisions through emotions. So ask yourself: “Is what I am about to do in keeping with my values?”In the insurance example, Jim valued an outcome in which he would pay no more than was necessary for what he thought was beneficial. He felt that his current plan was very valuable.For the man with the cardiac issue, he valued independence and vibrancy. He wanted a solution that would restore that.In Barbara’s case, she valued the commitment she and her children had made early on after her husband’s diagnosis: to care for him at home if it did not place any undue burden on her or her children.

  • Do the best you can; recognize that decisions are often iterativeJim had the option of continuing on his employer-sponsored plan for now and putting off a decision between traditional Medicare and his wife’s retiree benefit when he retired two years later.The man with the artery blockage wanted to have the catheterization and hoped a stent could be inserted. If need be, he will embark on surgery.Barbara decided to care for her husband with the help of her children and outside assistance. If the time comes where a move to a Memory Unit is needed, she will cross that bridge then.


As you and your families are presented with health care choices, always remember that clear cut, black and white decisions may not be possible.

Learning to live within gray areas of decision making by using some of the suggestions above can help you make choices that are both sound and comfortable.