Advance Direction Question

[starente15]

Hi everyone,
First, I meant advance DIRECTIVE!

I'm back with another question. Does anyone know, if in lieu of having an advance directive in place, if a verbal acknowledgement from a spouse that the PALS does not want life saving measures is sufficient? I've heard that in the event of a crisis that ends up in the ER "all life saving measures will be taken." Does that apply even if a husband or wife says the PALS doesn't want it? TIA!

 

[Schmidhogan]

I'm not sure that a directive by a spouse would work unless she has a power of attorney. No reason not to have the issues laid out in an Advance Directive. A do not resuscitate order would also be a good idea. These forms are readily available through hospice or your local ALSA.

 

[ECpara]

We did it online through Legal.com. It was quite easy but we did have to get it notarized. That may be a GA thing, we had to get the request for a handicap parking permit notarized in GA, too (not required in FL).

 

[Diane H]

Advance Directives can be one or more forms from a Living Will, a Medical Power of Attorney, or an Out of Hospital DNR (Do Not Resuscitate Order).
In order for a spouse or someone else to speak for the patient, he or she must have Medical Power of Attorney. This is easy to obtain and copies should be given to the hospital and any doctors involved in your care. The document only takes effect when the patient cannot communicate their wishes by any means including blinking or other movement.

It is true that EMS and emergency room personnel must do everything they can to keep you alive. In order to just be transported by EMS and/or cared for in the ER with only measures to keep you comfortable, you must have an Out of Hospital DNR form signed by your doctor. This frees them from the legal obligation to do CPR. Once you have been admitted to the hospital (being in the ER is not a hospital admission) The Medical Power of Attorney can be used if you cannot communicate.

 

[nebrhahe53]

What is sufficient for EMS is different in different states. Here you need a signed and notarized copy of a DNR(do not resuscitate) to wave in the faces of EMS or they are required by law to revive you. They will not listen to verbal requests.
Even so, they have the power to ignore this thanks to a 2011 lawsuit.
The advice I was given is if you dont want to wake up in the hospital ER, dont call EMS. If you have hospice nursing you (or your caregiver) can call them and they can administer drugs to keep you comfortable.

 

[starente15]

Does a spouse need a power of attorney doc or is it implied?

 

[Diane H]

Both a Power of Attorney allowing someone , even a spouse, to sign any papers for you or handle anything financial, and a Medical Power of Attorney require official documents. You can download these forms and others for your state here:
http://parentcarepro.com/state-by-state-eldercare-legal-forms-and-templates-2/download-your-states-dnr-form/22-legal-forms-by-state/58-durable-power-of-attorney-for-healthcare-by-state

 

[starente15]

My situation is that my parents are getting DNR paperwork today. I understand that what that means, but if he got in a crisis situation and was sent to the ER, technically still breathing, the DNR wouldn't matter. At that point, if he was unable to speak and the discussion turned to ventilation, I was wondering if my mother can say No for him or if we need power of attorney for her to make that call. The whole idea is stressing me out because I feel we are nowhere near prepared for any situation.

 

[gooseberry]

My husband, his brother, and I sat down and had a discussion about my husbands wishes. Then we went to a lawyer. A copy of the power of attorney and health care surrogate papers travel with us. If I cant or wont follow my husbands wishes, his brother can and the paperwork is in place. We were worried about familial challenges to my husbands decisions so we saw a lawyer.

 

[Nikki J]

Get every piece of paper you can think of and make sure you have alternates. Do you have siblings? That can be tricky. There are 2 schools of thought. If you have siblings with equal power and there is disagreement that can cause problems but if you are all on the same page it can be good in an emergency.
Are they going to a lawyer? They should see an elder lawyer even if he is not an elder. He needs power of attorney health care proxy or whatever your state calls it. Advanced directives plus the dnr since that is his choice and of course the usual will and if appropriate trust. It is overwhelming but you want everything in place

 

[starente15]

I would love to do all this but they keep resisting. I'm terrified of the outcome we could have with nothing in place. We have no lawyer involved, no paperwork being filled out. Nothing. They can't even talk about it.

 

[Nikki J]

Very hard. I am sorry. I do know someone who got around that by saying they needed to get their affairs in order( everyone should of course) and they all went together and did the paperwork. But that is not always practical especially as I think you live in another state?
For the PALS point of view it is a very hard thing. At least it is for me. So I get it. What would happen if you made an appointment with a lawyer? Would they cancel it?

 

[nebrhahe53]

If you wind up in an ER with no paperwork I think it is highly likely they will do everything to keep him alive, including a vent. Then, of course there will be the 300,000 dollar hospital bill if you dont have good insurance.
Pretending it isnt there wont make it go away, just even harder to deal with in the end.
I hope you can get things worked out.

 

[gooseberry]

Starente15, The conversation I had started with I know you dont want to think about this but to make sure your wishes are carried out we have to talk about it. He didnt say a word just listened. A week later I brought it up again. Then when I still had no response I aske dthe social worker to contact him and discuss "things that should be done". We made an appointment for the following week. Pals dont want to think about it but I laid out the mess it would leave, how his specific burial wishes may not be available if we were tied up in court, how he might be vented, etc. It gave him time to consider some things. Early on everything just seems to happen so fast!

 

[lgelb]

First, I have never worked at a hospital that would vent invasively over protests of the current spouse, and absent consent of the patient, paperwork or no. Proceeding without informed consent in an invasive procedure would suggest a lawsuit no matter what the clinical outcome. There have been a few cases in pregnancy, but that would not apply here. Moreover, as you know, most PALS do not vent invasively so there is hardly the expectation that they would.

And in ALS, breathing does not usually "go" to the extent that someone who has been able to communicate suddenly no longer can, until the end. So up until that point, the docs would be asking the patient (your dad) himself for consent.

But we are talking about being prepared, having that stress behind the family, everyone knowing what is to come, and that is all good. So we are talking about estate planning that includes:

1) your state's POLST, DNR or what have you
2) a health care power of attorney
3) a general power of attorney (have not seen this mentioned on this thread, but usually best to do at the same time)
4) Will [and trust, if desirable]
5) Advance directive that applies to your State

So by tying the two together (get control over what happens when you're alive and when you're dead), there is often more success in getting a "denier" on board. And it is not unusual for a couple to do it all together. And there should be a "package deal" for that.

Also, your parents can have an attorney come to their home (some attys waive travel fees for the terminally ill if nearby), as can increase the perception of control and some people feel more mellow after dinner in their own place. Ideally, the paperwork is done in advance via e-mail questionnaire so it is just double-checking and signing everything. The atty can bring or be a notary and bring a witness or grab a neighbor.

Either way, wherever the meeting is, if your parents are not in your town, you/your sibs can still "attend" via video call if all would like.