Advanced Directives Ignored--what are options

[nwsteve]

The conversation in the current LTC thread has prompted me to start this thread.
We hear so often the importance of having advanced directives to control our end of life journey but are then faced with hospitals that simply blow off the directives with apparent aplomb.
Do we need to take an attorney to surgery with us? Do we need our attorney on speed dial when the LTC facility, where our DF/DM/our self is residing, chooses to ignore the directive filed when the parent/us move in?
Kinda stumped on this situation and whether it an outgrowth of indifference, arrogance from the providers or just plain ignorance or worse complicity to bill as many services as possible.
Does have anyone have a protocol to insure a provider will honor a last directive?

[gayl]

I worked at a government hospital so I vote for:

Quote:

ignorance

as to whether there is a DPOAHC. I can we remember a few instances where the DP was not at the facility that the patient was at and the family ignored it. I'm not saying that's always the case, I have no idea how it works in for-profit hospitals for instance, but it would behoove the family and or patient to make sure that it's at every facility that they could come in contact with. For instance I'm a Kaiser Member. Kaiser has mine. If I am admitted to John Muir Hospital, Kaiser will be notified that I am at John Muir. It is then up to Kaiser to let John Muir know what my durable power of attorney is. Or my kids.

I can tell you that we did ignore my father's. There was a procedure that would have enabled my nephew (who he raised) to make it home from college. It was supposed to buy him anywhere from one to two days. He continued to struggle for the next 6 months. Was it the right decision? There's no point in second-guessing ourselves at this point. However, we did not pay attention to his wishes

[CRLLS]

My FIL had cancer, was going thru Chemo and had some breathing problems. He was admitted to the hospital for testing etc, After being given a relatively (considering the situation) clean bill of health and was being released. While dressing, he had a heart attack. Despite a DNR on file, the staff did everything they could and they did, in fact, raise him from the dead. He lasted about a few days and was determined to be terminal. He was released to hospice care where he didn't last another 24 hrs.


In the case of an emergency, i'm pretty sure that every employee in the hospital is not aware of every patient's DNR and DPOAHC on file. When something requires quick reaction, they do what they are trained and know what to do. I'm pretty sure that in this case, it was not deliberate that they didn't follow his wishes.

Not sure how the family would have handled the situation if they thought it was any different.

[JoeWras]

Still mad at the doctor who said to me: "I'm a doctor of the living, not the dead" when Dad asked for hospice care. He really screwed with my brain. Despite all of Dad's wishes, and what we heard him say himself, this doctor tortured our family.

It was like he wanted to use Dad as his end of life experiment and not release him to hospice care. Cruel.

[Teacher Terry]

My Mom made sure the VA hospital followed my Dad's wishes but it took a fight. Then after we left they tried to talk him into the surgery even though he was not legally competent. He refused to sign. When my Mom was dying she hung her DNR order all over her apartment. You would have to be blind not to see it. When I was visiting she told me if I found her dead to wait a few hours before calling anyone to make sure they could not bring her back. I would never override someone's wishes. Each person makes that decision for themselves.

[Blue Collar Guy]

Quote:

Originally Posted by JoeWras Still mad at the doctor who said to me: "I'm a doctor of the living, not the dead" when Dad asked for hospice care. He really screwed with my brain. Despite all of Dad's wishes, and what we heard him say himself, this doctor tortured our family. It was like he wanted to use Dad as his end of life experiment and not release him to hospice care. Cruel.

OMG, Im terrified of this entire thread. Just when you think you have all your affairs in order, there is a twist.

[Teacher Terry]

When we did not treat my friend's cancer that had Alzheimer's the cancer doctor would not okay hospice so I called the family doc and had her do it. There is more then 1 way to get what you need.

[JoeWras]

Quote:

Originally Posted by Teacher Terry When we did not treat my friend's cancer that had Alzheimer's the cancer doctor would not okay hospice so I called the family doc and had her do it. There is more then 1 way to get what you need.

Right. To the OP. Fight it. Use whatever means you have. You may have been joking about the attorney, but it isn't a joke. Not a bad idea to have a letter from them.

[Teacher Terry]

Joe, I am so sorry your Dad had to go through that. Doctors need to realize that dying is a normal part of life and they are not God.

[aja8888]

Quote:

Originally Posted by Teacher Terry Joe, I am so sorry your Dad had to go through that. Doctors need to realize that dying is a normal part of life and they are not God.

I've seen more than one "Medicare feeding frenzy" carried out by doctors. That ain't happening to me or DW.

[Blue Collar Guy]

Quote:

Originally Posted by aja8888 I've seen more than one "Medicare feeding frenzy" carried out by doctors. That ain't happening to me or DW.

So what do you do to avoid this? Im going to ask an attorney . But you have any idea for now?

Oh man, now its even worse, they are doing it for the money, ugh. Im totally disgusted now.

[Teacher Terry]

Most people have more then 1 doc. If one won't do it ask another. The cancer doc was so used to saving her and had done so 8 times in past. For him it was emotional. She was his great success story. The hospital even made a commercial about it. I just took her to the family doc that said it was the right thing to do since she had Alzheimer's. I can't believe all the docs a person sees would be unethical.

[ncbill]

The "living will" was the old way of advanced directives.

It usually had pretty generic language like "no heroic measures" and placed burden of interpretation on a doctor who likely had never before seen that patient.

The new way is a health care POA. Each state usually has a model form or forms.

Those appoint a health care agent, much like a financial power-of-attorney, to make decisions when the patient cannot.

Language is much more specific, e.g. no feeding tube, no IV antibiotics, no CPR.

Certain medical situations (like surgery) can force the health care agent to consent to a temporary waiver.

Again, you've got to pick a health care agent who will carry out your wishes.

A final horror story to motivate everyone to follow your loved one's wishes:

One of the most heart-wrenching things I've ever read online was from the DW of a advanced-stage, bedridden dementia patient, who ignored their DH's wishes and had placed a feeding tube.

Unfortunately, dementia patients don't like to have things attached to them, so he soon yanked it out.

The first time they got it re-inserted without complications, but the next time the site became septic which then led to an unpleasant death.

[Clone]

Quote:

Originally Posted by aja8888 I've seen more than one "Medicare feeding frenzy" carried out by doctors.

When my mom decided to move to hospice, there was no challenge from the hospital doctor. He was great to work with.

The hospital had a person who was responsible for transition services, to make the move to hospice smoother (that is what she said). She then asked my mother when she last had a pap smear! Even my mother laughed when I said "Are you sh$%&^$^ me?"

Obvious that the hospital was determined to find every possible billable item that they could...

[Souschef]

I am still upset at my sis. While in the hospital, my Mom. who was 101 and had no quality of life, stopped breathing. She had a DNR, but my sister selfishly said she was not ready to have her go. She lived another year with full time care to the tune of 6K a month.

[Meadbh]

Quote:

Originally Posted by Souschef I am still upset at my sis. While in the hospital, my Mom. who was 101 and had no quality of life, stopped breathing. She had a DNR, but my sister selfishly said she was not ready to have her go. She lived another year with full time care to the tune of 6K a month.

In my experience it is inability of a family member to accept the inevitable that causes the greatest grief.

[Souschef]

Quote:

Originally Posted by Meadbh In my experience it is inability of a family member to accept the inevitable that causes the greatest grief.

Well said

[nwsteve]

Quote:

Originally Posted by Clone When my mom decided to move to hospice, there was no challenge from the hospital doctor. He was great to work with. The hospital had a person who was responsible for transition services, to make the move to hospice smoother (that is what she said). She then asked my mother when she last had a pap smear! Even my mother laughed when I said "Are you sh$%&^$^ me?" Obvious that the hospital was determined to find every possible billable item that they could...

Almost as good as the conversation my DW had with an attending physician for her mother shortly before her mom entered hospice and passed away about a week later--the doc wanted to do a colonoscopy on her soon to be deceased mother. The doc does not know how lucky he was that I was standing between him and my DW!

[Blue Collar Guy]

Quote:

Originally Posted by Meadbh In my experience it is inability of a family member to accept the inevitable that causes the greatest grief.

+1 I'm GUILTY of this.


My sister the Phd. was married to a M.D. She was dying of pancreatic cancer at age 49. When the end was coming , my brother -in -law decided she would not be fed thru the tube. At the time I was still expecting a miracle , I told him if he didn't let them feed her, it would be a double funeral, hers and his. He had her fed. She lived maybe 3 more days, the miracle didn't come. Im convinced I kept her alive for a while longer, and I prolonged her agony. Worst move I ever made. I have no clue what her wishes were. But Im positive it would not have been to live like that for a few more days.

[Meadbh]

Quote:

Originally Posted by Blue Collar Guy +1 I'm GUILTY of this. My sister the Phd. was married to a M.D. She was dying of pancreatic cancer at age 49. When the end was coming , my brother -in -law decided she would not be fed thru the tube. At the time I was still expecting a miracle , I told him if he didn't let them feed her, it would be a double funeral, hers and his. He had her fed. She lived maybe 3 more days, the miracle didn't come. Im convinced I kept her alive for a while longer, and I prolonged her agony. Worst move I ever made. I have no clue what her wishes were. But Im positive it would not have been to live like that for a few more days.

I can’t imagine the agony this caused both of them. I presume he mo longer speaks to you.