Going forward without POA (health)

[FruHagen]

How do you navigate situations where your loved ones health is so bad but you have no POA?

Do the health authorities continue to treat and medicate even in the face of severe issues? Or do they stop and discuss with family members at any point?

Even if they did my family members are imo overly optimistic about the chances of recovery and pursue every opportunity for interventions. I myself am struggling to know what rights they even have to push for things without PoA and if at any point the health services are going to advocate for stopping everything (feeding tubes, hospitalization, nursing, antibiotics etc. etc.) as it is prolonging a very poor quality of life.

Any input gladly received. I have no idea how to talk to anyone about this. I just don't understand the system or how to even think about this issue.

I'm not in your shoes but hoping to bump this for you and that someone who knows about this stuff comes along. If you can give more information about what's wrong with your relative, age and involvement of any agencies like social services it may help.

DM is now end of life with dementia. We were fortunate to be put in touch with a team that has explained what certain interventions would entail and achieve. We all know our mothers views and do our best to follow them. It's still difficult at times because there are little decisions all the time that we question. The bigger ones are easy for us. DM was a nurse and was vocal when well about her thoughts on cruel and unnecessary interventions at end of life and that she did not want this. This and us holding an LPA makes things so much easier for us.

I'm sure my in laws would probably override this and do what they felt they should do and take action as they would feel bad for not doing it and would feel that people would judge them for not doing it. I think they also do not fully understand the consequences of these kids of actions. If for example you are in a similar position to me then you may not want relative to be resuscitated as it's absolutely brutal and pointless now. Your family may not understand this and might benefit from you asking professionals in front of them what this actually entails, same for tube feeding and so on.

Such a sad and difficult situation. I don’t know about the issues concerning LPA. However I wonder whether you could speak to the doctors consultants care home manager if there is one and express your concerns about your relative suffering, very poor quality of life, question the value of further interventions, ask for information about what the benefit of the proposed treatment or intervention is in the short, medium and long term. If the suggested treatment is not going to help any sort of recovery then make sure this is pointed out to your siblings etc? You might need to choose your words carefully.

You need a chat with the consultant or GP about it, make your thoughts known.

I've found that even WITH a LPOA, medics carry on regardless , doing what they think is right, until pulled up and the LPOA waved in their face

We were told to sign a Respect Form (DNR) TOLD , please note. Naturally we thought and talked about it and in the end DID sign it, but the LPOA was not mentioned by the medics nor taken into account

What I'm trying to say is, ime the LPOA hasn't been very useful. Unless we've really pushed the fact we have one. And even then , there are medical protocols which over ride it.

I'd sit with the Consultant / GP and ask what they will decide and explain what you'd like to happen and see how the conversation goes

BTW a finance LPOA is really useful

From my experience if you lean towards not wanting too much intervention you’ll be fine. Medics and nursing home I dealt with for my dad were keen to take on board our point of view. I had no health POA and it was never a problem.

However if members of the family disagree then holding a health POA might not have helped much anyway if it were held jointly by people who disagree.
If it’s eg your dad, aunt and sister pushing for extension of life at all costs then it’ll be tricky to get your point of view heard. If you and your dad are agreed then clearly easier.

Thanks for your input everyone.
It's my DM, 86 and in a nursing home after a very serious stroke a year ago. She lost her ability to swallow and was tube fed then put on a peg. I didn't understand the implications of this when it was happening. I was not in the doctors meetings but my older siblings were. She can swallow now but won't eat anything really.
She is also paralyzed, with dementia and has suffered a further stroke and a fractured hip during transportation to the hospital. There is also a long list of health issues including double incontinence, hallucinations and pain.

I believe that myself and my siblings are not on the same page regarding all this. Many things have happened to save her life that I don't necessarily agree with, for example in the early aftermath of the stroke I tried to raise the issue that maybe what would be best would be to bring her home and not give her any interventions and all of us be with her for however long it would take. I don't think anyone understood what I was saying or if they did they didn't want to hear it.

Conversationally I have said that I myself do not want any interventions if I am in the same position in my old age, but my siblings said "oh, you can't do that to your kids".

It's very difficult to discuss any of this as I think my siblings think there may be a miracle coming. I think a good death is what my beautiful DM deserved. Death is almost a taboo to talk about and it is part of the reason we don't have PoA.

Oh fruhagen I feel for you.

I'm finding myself being the constant voice saying 'give up, let go' on these boards and I need to be careful about that. Please bear that in mind reading this.

People can always refuse medical treatment, but they can't demand to have it (well, they can, but doctors can't be forced to do any treatment they think is not appropriate). If the person has no mental capacity for a specific decision on medical treatment, their GP or consultant can decide for them. This decision should be in their best interests, in consultation with loved ones, and the least restrictive option.

A LPOA means that, if mental capacity for a decision has been lost, the attorney becomes the decisionmaker on refusing medical treatment. They should then make the same sort of best interests decision.

In my view, the problem arises if you don't want treatment- the opposite of the above! I believe elderly people are grotesquely overtreated medically, in hospital far too much, and 'under cared for' if that's a legitimate phrase. My mother's life was saved after a brain bleed almost 18 months ago, for absolutely no point whatsoever. Her life is completely meaningless now and should have ended then. She has also since then had multiple courses of antibiotics, which in my view were cruel and inappropriate. We finally, finally got antibiotics crossed off her drug chart after multiple fights with doctors and staff. My sister and I have become tough and stonyhearted (in their view) but we know our Mum's wishes. I am lucky that I know this was her wish. Unfortunately I was never able to persuade her to give us POA for health. She also never dated or got her Advanced Directive witnessed, which made it useless. Nonetheless I am certain of what she wanted. They don't know her.

Doctors are too likely after a stroke to just say 'we put a PEG in after a stroke' (that's a quote from a consultant about a patient I was involved with). Ludicrous. The family had already stated as clearly as they could that they did not think their beloved relative, who lived with them all their life, should have a PEG. The consultant ignored this.

I think you were right about your DM. And I'd urge you to get your PoA in place and tell your attorneys what your wishes are, loud and clear. I'm afraid I think 'you can't do that to your kids' is simply ignorant. What i have suffered for myself and on my mother's behalf due to overtreatment and lack of a POA is close to unbearable. Far worse than grieving a short illness and a peaceful death - my Dad had that and thank goodness for it.

I can't honestly recommend that you speak up. I had everyone - doctors, nurses, therapists - look at me as if I were Lucretia Borgia when I dared to say 'if things take a turn for the worse could we consider a less active form of treatment?' Like it was unthinkable that an 88 year old man with one lung post stroke had every bit as much chance of full meaningful recovery as a 45 year old. And I've seen other relatives who speak up treated that way too.