End of Life letter

[Laylabud]

Mum has just been moved into an EMI nursing home and i have been given an end of life letter to fill in, which nobody wants to think about. I am sure many of you have been in situations where there are more than one sibling, if neither agree with CPR what position does this put the home in, who's wishes do they adhere to?
Any comments/advice would be apreciated.

Best Regards

 

[christine_batch]

When my husband was admitted to a E.M.I. Unit, Peter made his wishes known when he first knew he had AD.
The N.H. and the Doctor have the information and on Peter's medical file is DNR.
Best wishes
Christine

 

[Skye]

where there are more than one sibling, if neither agree with CPR what position does this put the home in, who's wishes do they adhere to?

Hi Laylabud

I'm not sure what you're asking here. If you and your siblings decide on DNR, who is saying they should resuscitate?

Like Christine, I was asked this question when John was first admitted to a NH, and I also said DNR.

To me, it makes no sense to artificially prolong life when all quality is gone.

But it's a controversial issue, and I know some people will disagree.

Could you explain what exactly the problem is?

Love,

 

[Cate]

Hi Laylabud

I think what you are asking is what if the siblings do not agree, eg. some are for, and some are against DNR. I am not sure if there are any legal implications, but I would have thought that the eldest is considered next of kin, and therefore thats where the decision rests, but I would think you would need to check that out.

Whether to ask for DNR is a very personal decision, my brother and I both agreed at the time of mum's heart attack last year that this is the best decision for our mum. The hospital, GP and NH are all aware of this, and its documented on all mums files.

Best wishes
Cate

 

[jenniferpa]

The problem is: a DNR and/or next of kin's wishes are always going to be subservient to the doctors' opinions. Now, obviously most doctors will take account of the previously expressed wishes of the patient or the wishes of the next of kin but they don't HAVE to. And that cuts both ways: even if someone is adamant that heroic measures should be taken to keep someone alive, doctors don't have to follow those wishes. All they have to do is show that they acted in the best interests of the patient no more, no less, and when someone is in the latter stages of dementia and are elderly it's unlikely that ethics boards would consider it reasonable to keep someone alive at any cost.

 

[Canadian Joanne]

I think the NH would go by the direction of the power of attorney. That's what is done here so I'm assuming it would be the same. Why not ask the home? It's the legality of the matter that would be the crux of the matter, I suspect.

 

[Skye]

It would depend on the POA, Joanne. The old version in England and Wales didn't cover welfare. The new one does, but I believe the doctors still have the power to ignore 'in the interests of the patient'.

 

[Laylabud]

Thank you all for your replies.
My Mum is at the stage at the moment where she is very mobile and since moving into a home she has started to talk a little more, given this at the moment i do want CPR carried out on her if she has a heart attack etc as i feel at this stage it would be unfair not to give her a chance to live her life a little longer, if she becomes bed bound and has to be fed then i would have to re think things.
I am the younger sister and i feel that my sister would not want Mum to be revived, i have been her primary carer for the last 11 years.

 

[Skye]

Thanks for the explanation, Laylabud. I wondered if that was the case, but didn't want to jump to any conclusions.

I understand completely where you're coming from, and I think you really need to talk things over with your sister. The last thing you need is a huge argument if your mum is critically ill.

I think you both also need to talk things through with the care home manager/head of unit. You could explain how you feel, that you do not want DNR yet, but would reconsider if your mum became more frail and dependent. I'm sure thay would back you up in this.

Good luck, and let us know how it goes,

 

[jenniferpa]

Do you know why your sibling feels as they do? Is it a generalised "mum wouldn't want to live this way" or is it more specific? I ask, because resusitation is not exactly as it is seen on TV. It can more closely resemble a violent assault from watchers point of view (broken ribs are very common). Furthermore, outcomes aren't as positive as you might imagine - studies show that rarely do more than 10% of patients who are subjected to this survive to discharge, and many studies show even smaller survival rates.

I am personally ambivalent about it - my mother had a grand mal seizure right in front of a care worker (stopped breathing) , who immediately started mouth to mouth and CPR and called an ambulance, and she lived for another year with no ill effects due to the resusitation. However, it was a year of pain and distress from her other ailments and on balance, I can't help feeling it might have been better if the seizure had happened when no one was there.

As Hazel said - you really need to discuss this now, even if the decision you make will not be binding.

 

[Canadian Joanne]

doctors still have the power to ignore 'in the interests of the patient'.

Hazel, good point. I'll have to check ours here. It does depend a lot on the patient. At this stage, my sister and I are both agreed that DNR is in order. We've also agreed not to have antibiotics prescribed in case of pneumonia. We only want comfort care from hereon in.

Laylabud, since your mother is still mobile and talking, I understand your wanting to resuscitate her if necessary. Bear in mind what Jennifer said though. It really is quite as aggressive as Jennifer said, with the same poor results. I actually had this conversation again with my own sister last night & we quickly agreed on the points I mentioned above. I was surprised, as I thought my sister would want Mum to hang on like grim death. But my sister had seen her for the first time in over a year and was devastated by the changes. Do have a long talk with your sister. You may not need to come to a decision right away and several more talks in the future would probably be a good idea. That's what my sister & I did and our opinions and decisions did change over the years.

 

[Laylabud]

Thanks for all your comments so far. The reason why my sister would not want my Mum revived is not because of the illness but for other more personal reasons which i really do not want to go into at this point except to say that she has had a copy of the letter for nearly a week now and there has been no feedback from her at all, since Mum moved she has been up to see her once and lives about 5 mins from the home.

i have taken on board all the various comments and there have been some things mentioned that i had not thought about, so i will carefully re think things over.

Thanks