Doctors confused by living wills, study shows

sushipup1

It's a great idea to have your living will should you need it, but a recent study shows that doctors often don't understand it or your wishes.

Doctors confused by living wills

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sunnyca_gw

All dr. needs to see is the DNA or medical directive page, rest is none of their business!

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sushipup1

"rest is none of their business!"


Do you know what a Living Will is?

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mdln

Not surprised, living wills are considered legal (vs. medical) documents, created by attorneys.

The current trend is use of POLST forms that give more information than just DNR orders.

http://polst.org/

Encourage all to have someone with a durable power of attorney for healthcare, who can speak for you when you are unable to do so.

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maifleur01

This is especially true for people who are living together and not married. Family wishes will override your wishes unless they are in a legal document. Older couples are some times hit with this when on develops health conditions and is whisked away to a nursing home by family. One of the main reasons that so many gay men and women wanted to be married so that they could take care of their loved one. Even having a polst form is often not enough you need that legal Medical POA written and witnessed.

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sunnyca_gw

Is there a difference in Living trusts than living will & yes we all had attorney draw them up,(parents & I) 1 hospital wanted whole trust on my dad, I said no way, & gave them the medical directive page, that is what every hospital was wanting to see.

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sunnyca_gw

Medical directive is durable power of attorney medical, 2nd 1 is for rest of trust so someone else could take over finances if parents couldn't manage them any more.

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sushipup1

If you read the story, you will see that this document has nothing to do with finances.

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maifleur01

If you read both of our comments you would understand sushipups comment about 2nd 1. The hospital wanted a copy of the complete trust document to probably see if there was someone directed to pay for the patient. She gave them the only the medical document.

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raee_gw zone 5b-6a Ohio

Everybody is confused about these directives. House staff, the people signing the documents, and their families. Living will is written for a very narrow circumstance, and the language in it is very clear (I think) but people tend to think that it applies to many other situations.

Something that I see is that a seriously ill person has designated a medical power of attorney, but he is at that point still competent to make his decisions (ie does he want surgery); but the medical team asks the POA instead of the patient. Kind of an assumption that the patient has deferred to the POA to make the decision, even if he is not sedated, or delirious -- and actually, legally, the POA is not in effect when the patient is competent.

Also, some hospital personnel tend to assume that "do not resuscitate" should mean "no treatment" beyond comfort care. But, treating an infection or setting a fracture can be perfectly appropriate, depending on the actual situation and condition of the patient. Likewise, life support can be inappropriate for a person -- because it is futile, and will not lead to recovery -- but the decision maker doesn't understand or fears making the choice to let go.

All this argues that people need to learn about modern life sustaining measures, think about what they want, and discuss it with their family.

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mdln

@ raee, unfortunately you are correct. I teach emergency medicine and "DNR does NOT mean do not treat" is something I often need to remind staff about. I hope migration to POLST forms will help.

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maifleur01

An aside to this and perhaps better for a separate thread but it goes with the do not treat. My husband had a down turn in January and the doctor thought he was ready for hospice. Off hospice now.

When I told family that it had happened a couple who had gone through the 1980's AIDS and several other end of life situations told me that at that time all medications were withdrawn. This is not what happens now but some may not know that the criteria had changed, if it ever was that way. I was surprised when I checked that there were so many different actions depending on type of disease. Although it was not listed in any of the criteria not treating is a loved ones decision and can be a blessing for the person that is dying. I refused sending him to the hospital when he developed heavy chest congestion because for him dying of pneumonia would be better with his dementia than slowly dying when the ability to swallow disappears. Although I have discussed this with his children and partners some are wanting to keep him alive at any cost. They do not understand what the cost to him would be.

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sunnyca_gw

Neighbor lady never smoked but got lung cancer3 yrs ago. Tried pill chemo but got so she couldn't even walk ( so weak) & eat as mouth sores so bad. She was put on hospice & got pain meds, hospital bed in LR. She was carried to car & told dr that day, no more chemo, couple days later she was running around house & cut up a chicken for supper. She did well during days but couple weeks later he took her to hospital for pneumonia(she had volunteered there for years) hospice had a fit but she did better for probably a month after she got home & was pretty comfortable. Then needed more morphine & didn't last long. Being treated for the pneumonia gave her at least another good month but she had been pretty healthy before she got cancer. Lasted few months. In her case right thing to do as pneumonia was causing the shortness of breathe. Each case is individual.

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sunnyca_gw

raee- I refused to take the POA in on either of my parents, all 5 of us kids & folks had talked about what they wanted & did not want but from experience we all knew they are quick to "finish you off" out here in some hospitals. Both had high BP but were able to manage it most of time, mom got fluid on lungs & had to have treatment for that 3-4 times over 4 yrs. I brought the POA in after dad had 3 heart attacks & said "no more" this is it, just pain meds. Mom's POA was brought in by me when she said she was through with treatment, everything seemed to be making her worse, couldn't get IV lines in bruised all up & down arms etc, so that is when they got it.

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raee_gw zone 5b-6a Ohio

Sunnyca, that worked out well for you and I am so glad that you and your parents and siblings had talked about things. If you had given the POA paperwork to the hospital earlier, though, why do you think that would have anything to do with "finishing them off"? POA does not make people DNR, or change their care -- it only allow YOU to have the right to say what should or shouldn't be done for your parent if and when they can't speak for themselves.

What could have happened, and does happen fairly regularly when there are multiple family members involved without a POA designated, is that one child wants to do "everything" without an end point, another doesn't want to discuss it, a third wants to let nature take its course, and so on. It sounds like that would not have happened with your family, but I have seen it happen that the POA never brings the paperwork and doesn't realize that another family member has claimed the decisionmaking role and is having discussions with the MDs and making choices that are against the patient's (and POA's) wishes.

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