Father-in-law is Refusing Operation

[Leonora7]

Hi All
I have not posted on this forum since 2014 when my parents (for whom I was a carer) both passed away. Now it is my husband’s turn to care for his 89 year old father. Again, he is 65 miles away but this time there is no prospect of moving closer so the care is largely remotely managed with employed (and excellent) carers. Jack has never been diagnosed as having dementia but it is obvious to anyone with the smallest knowledge and/or experience that he is now in the later stages of the condition.

This post concerns his physical health. My husband and his brother had LPA for financial affairs but not health. When I acquired LPA for my own father it was not easy or, indeed, advised to try to obtain the health LPA but it seems from a quick perusal of these forums that that has now changed. Jack has been fitted with a catheter since the end of last year and is now meant to be going into hospital next week for an operation to sort out his enlarged prostate. Yesterday we had a family lunch and my husband mentioned the forthcoming op; of course jack had forgotten about it but seemed unfazed. However, brother-in-law returned jack to his home after lunch and Jack declared that he did not want to have an op. What we are wondering is what we should (or indeed can do). The ramifications of having or not having the op are manifold and we really can’t decide on the best option. But, essentially, should we just tell him he’s going in to have the catheter removed (technically true) and hope he does not make a fuss once there or should we cancel the procedure. Any advice would be very welcome. Thanks in advance for your help.

 

[love.dad.but..]

I had health poa for my dad so when he needed an urgent op without his awareness or agreement but with full support of the surgical team it was not a problem. However I may be wrong but I think what you suggest is not an option as doctors even if unaware of his advanced dementia will need consent and forms signed...they may well take a best interests decision that it should be done although may hesitate and need discussion with others. If he has enough mental capacity and understanding still to remember a conversation about the op and express an opinion then I don't think it would be wise to fool him into a more involved op and before the op the procedure and risks presumably would be explained to him before he signs when he night refuse. If he is still deemed to have mental capacity then he has the right to refuse I guess. It is a difficult situation ...your OH could try speaking to the hospital before the day to explain...whether without poa they would discuss.

 

[Lawson58]

I think it partly depends on what sort of procedure is planned for Jack. The surgery my husband had was not particularly complicated and was very successful, and he had suffered a cardiac arrest only a few months earlier.

If his overall health is not too bad, I would be inclined to proceed as if he hadn't changed his mind and hope that he goes along with it when you get him there. I hope everything goes well for him.

 

[Linbrusco]

Is your FIL having a TURPS procedure?
My Dad had cognitive impairment and had this procedure in 2014.
He had put it off for 8 yrs. He retained a lot of fluid and his kidneys were impaired.

When filling out his paperwork I added the fact that he had cognitive impairment and needed post op instructions communicated simply. As it was he didnt , and once his catheter was removed he wouldnt call the Nurse to take him to loo, therefore didnt use the special container to measure urine output and spent an extra day in hospital, until they were happy with his discharge.
Dad also had a spinal block.

With Dad when signing consent forms Surgeon & Anaesthetist asked Dad why he was there and for what procedure and did he agree.
With having dementia and no POA Im not sure how that would go?

 

[Leonora7]

Many thanks for the replies; it has given us some food for thought so we think we will just go with the flow, i.e. take Jack in to the hospital and see how things go. If there is a problem and the hospital consultant/staff cannot persuade him that the operation is in his best interests then we will just have to accept that the catheter will remain.

Interesting about the Health LPA as I was told (about 10 years ago when taking Dad to the solicitors to arrange his Finance LPA) these were rarely granted. Seems to be different now.

 

[Leonora7]

Yes, BTW, it is a turps procedure. Despite our observations that he is not very healthy the pre-op visit went smoothly and he has been offered spine block or full general anaesthesia. He had expressed a desire to be knocked out completely but, of course, if he goes ahead with the procedure, he may be persuaded otherwise on the day.

 

[Beate]

I'm wondering whether you could speak to the consultant again. It's quite normal for someone with dementia to change their mind every time a topic is brought up, so best not to mention it anymore now, but have you been told about the ramifications of general anaesthesia? They can cause temporary or sometimes permanent confusion in people with dementia, and should be avoided if at all possible.

Just as an aside, health deputyships are rarely granted, but health LPAs are granted as easily as the financial ones. So if Jack still has capacity you should seriously think of getting him to sign one. You can fill in the form very easily online and don't need solicitor input for it - the only outlay would be £82 for registration with the OPG.

https://www.gov.uk/power-of-attorney

 

[nitram]

Interesting about the Health LPA as I was told (about 10 years ago when taking Dad to the solicitors to arrange his Finance LPA) these were rarely granted. Seems to be different now.

If you go back just over 10 years to before Oct 2007 it would have been an EPA, there was no health EPA. The solicitor could have been talking about a COP deputyship.
Deputyships and EPAs were introduced with the formation of the COP, EPAs were soon replaced by LPAs.

 

[Leonora7]

Ah, evidently not 10 years ago then as it was an LPA I had for Dad. I also had to obtain deputyship for my Mum as she refused to agree to an LPA - that one I did myself which was very time-consuming but gave me a sense of achievement.

 

[Ellaroo]

I agree with what others have recommended, dad may change mind regularly etc.,id be economical with truth if drs say its in his best interests medically . Play it by ear, i do . I find with mum you get surprises both good and bad . Hope it works out for your dad

 

[Louise7]

Just to add to what's already been posted, my Mum is currently in hospital and needs an exploratory procedure. I spoke to a consultant yesterday and was asked for a copy of the H&W LPA and signed a document giving my consent for the procedure to go ahead. I asked what would have happened if I didn't have LPA and was told that a best interests meeting would be held and the decision to go ahead with the procedure would be based on clinical need. The lack of an H&W LPA for someone with dementia would not prevent the procedure going ahead if it was medically required.

 

[Lawson58]

Yes, BTW, it is a turps procedure. Despite our observations that he is not very healthy the pre-op visit went smoothly and he has been offered spine block or full general anaesthesia. He had expressed a desire to be knocked out completely but, of course, if he goes ahead with the procedure, he may be persuaded otherwise on the day.

If he is able to cope with the epidural rather than general anaesthetic, it would be better as there would be fewer problems with confusion etc. My husband has severe heart problems and can't have an epidural but he was fine afterwards. Hope it goes well.

 

[Leonora7]

Thanks again to everyone. Fingers crossed for next week.