Advanced directive and POA for health and welfare

[CHEZA27]

Hey. I was wondering if someone could help explain the difference between a DNR order and and order of no life sustaining treatment. My mum has a DNR in place and has done since 2016 when she had her stroke. Before she was poorly mum made a Lasting Willl and testament amd advanced directive. In it she put that she didn't want any life sustaining treatment. I've taken this to include no ventilation, no resuscitation, no food tubes/Pegs etc..

My mum is currently in hospital as she had three aspiration episodes and a chest infection. There is talk of her swallowing declining because her dementia is deteriorating a lot, we think that the aspiration is due to this. She is on the highest stage of food puree. So I need to now have some conversations with the SALT about what happens next.

Mum already has everything done for her and the quality of life is just not what I think she would want.

I suppose what I'm asking is has mum already provided me with the answer to the above, do I have the conversation with the doctors and the SALT?
What does life sustaining treatment mean for others?
Has mum already given me the answer in her AD, as her LPA do I need to follow through with her wishes or is there anyone that can override the decision, like another family member or doctor?

Thanks in advance x

 

[Lemondrizzle]

We were told by MIL's doctor that he would make the decisions regarding treatment, not another family member. This came about because we were concerned another family member would push for resucitation if they were visiting and there was a medical issue (had the discussion because this had already happened with a family member in a different hospital).

DNR is attempts to restart the heart and/or breathing if either stops. Resucitation is brutal and rarely appropriate anyway in the elderly.

Life sustaining treatment is that which keeps life going. In the circumstances you describe I would speak to the doctor responsible for her treatment and discuss withdrawing treatments. In my experience so far, advance directives have been taken very seriously where it is clearly appropriate to invoke them.

 

[canary]

I have had these discussions with the doctor when OH was in hospital with sepsis. He already had a DNR form and it was agreed that things like ventilation, artificial feeding (tubes/PEG), kidney dialysis etc would not be appropriate. They would still treat him with IV antibiotics, ordinary oxygen etc, but not the life sustaining treatments. It was all recorded in his medical records.

I think you would need to talk to the doctor about your Mums advance directive so that it is recorded in her records.

 

[Banjomansmate]

The Banjoman had an Advance Directive and I made sure it was brought into play after he deteriorated badly after falling and breaking his femur.
The third time he had fallen and was taken to hospital from his Care home because they feared he might have had a stroke, I took the AD with me and spoke with the Consultant in A&E and she agreed that in future, unless he had a major injury i.e. broken bones, he would not be taken to hospital. After discussions with the Care home manager and the GP his records stated that he was to be kept comfortable but no treatments were to be given. As it happened he deteriorated suddenly and was allowed to pass away peacefully a few days later.

I am in the process of setting up an AD for myself and was surprised when the Solicitor said that the Health & Welfare LPA over rode the AD because the attorney takes on the legal responsibility for decisions but should recognise the donors wishes. I don’t know if she was right but at least my family will have my wishes written down to show any Doctors.
They are my attorneys too.

I found it was no good relying on details like that being in The Banjoman’s hospital notes, I took copies of the LPA and the AD with me on every admission to hospital because they were never in his “current” admission records and they photocopied them every time!

 

[canary]

I found it was no good relying on details like that being in The Banjoman’s hospital notes, I took copies of the LPA and the AD with me on every admission to hospital because they were never in his “current” admission records and they photocopied them every time!

That is a good point. You do have to make sure that the advanced directive is put in her medical records each time that she is admitted.

 

[CHEZA27]

Thank you, I have asked for a new copy from the solicitors as the old one was damaged. They said they will send me one which is good. The home have the LPA anyway and there are copies in her notes as well.

 

[CHEZA27]

The Banjoman had an Advance Directive and I made sure it was brought into play after he deteriorated badly after falling and breaking his femur.
The third time he had fallen and was taken to hospital from his Care home because they feared he might have had a stroke, I took the AD with me and spoke with the Consultant in A&E and she agreed that in future, unless he had a major injury i.e. broken bones, he would not be taken to hospital. After discussions with the Care home manager and the GP his records stated that he was to be kept comfortable but no treatments were to be given. As it happened he deteriorated suddenly and was allowed to pass away peacefully a few days later.

I am in the process of setting up an AD for myself and was surprised when the Solicitor said that the Health & Welfare LPA over rode the AD because the attorney takes on the legal responsibility for decisions but should recognise the donors wishes. I don’t know if she was right but at least my family will have my wishes written down to show any Doctors.
They are my attorneys too.

I found it was no good relying on details like that being in The Banjoman’s hospital notes, I took copies of the LPA and the AD with me on every admission to hospital because they were never in his “current” admission records and they photocopied them every time!

Thank you. That's very useful. There are copies anyway I just needed more understanding. I had also been told that the LPA over ride the AD and that I would be the one ensuring that her wishes were acted on. I have since spoken to her GP and she is in agreement with mum's wishes and thinks it is appropriate. However hard it is I know it's part if my role as her LPA.

Thanks

 

[silkiest]

Hi @Banjomansmate the hospital doctors made it very clear to me that unless the LPA health specifically says how to deal with end of life or life sustaining issues, that the doctor will make the decisions in the persons best interests and they have the final say on treatment although they will discuss with relatives. I have been very specific in my own personal LPA that if I am unable to make my own decisions due to any form of dementia I do not want treatment. I suppose it depends how you have worded your LPA as to whether you need an advanced directive or not.

 

[Banjomansmate]

It was our Solicitor who suggested the AD to The Banjoman when we were getting his LPAs organised. I had mine already in place but with nothing specific about end of life care, which is why I want something now, having seen how useful it was when I had to negotiate my way through his Care needs and cope with his family coming up with comments like “But he might not want that now”. At that point he was swearing and hitting out at medical staff and refusing all physical treatment, had no idea what was going on and lacked capacity to make any decisions.

 

[silkiest]

I can understand why you want it in place. It would be cheaper to re do LPA health online yourself but hopefully your solicitor has the AD just as you like it