Power of Attorney - Help with Instructions re End of Life Decisions Please

SKA123

BikingBud said:

I'm now stepping into where I wasn't going to and I am not a specialist but I am being objective and feel it is important that we have these discussions objectively, so trying really hard to not be judgmental.

You have no close family and being blunt nobody that sees it as essential that your lives are sustained. Yet you wish to sustain those lives even if you are unaware of your own being and you are suffering?

• withdrawal of care which would end life prematurely - Some die young but have had lives full of love, joy and satisfaction, others die old, alone and in pain, suffering. Where do you perceive this premature line to be?
• where the focus was on sustaining life rather than hastening death. - Death is the only certainty, it will come to us all.
  
• We both feel strongly about wanting all medical interventions possible to live - At what cost? And to the detriment of which other patients, perhaps more needy patients? Think Schumacher, the commitment, the cost and then wonder how anybody else could deliver that for you.
  
• I would prefer not to move into residential care and I would like to be cared for at home - How does that balance with the wants above. If you do get left at home then it is quite likely life sustaining treatment cannot be delivered and treatment wlll be withdrawn.
  
•  I would prefer to die at home - Again this is likely inconsistent with your demand to sustain life. Moreover when it is realised that life cannot be sustained who would you expect to take you home?
  
• My attorney can decide that I am to move into residential care if I can no longer live independently AND I can no longer be cared for at home - Whilst you may wish to give them authority to decide can they actually deliver to your wish, have you put in place the necessary funds to ensure this can be achieved? Else the attorney will at best be able to represent your wishes.
• For religious reasons, my attorney must not consent to life-sustaining treatment being withdrawn even if for example I am in a persistent vegetative state or terminally in pain - It might be that this is not their choice as medical staff might be under far greater pressure and be working to constraints that are determined to be more important than your desires. Terminally in pain would suggest that death is near perhaps you mean perpetually?

I feel that setting wishes to decline ongoing treatment, signing DNRs etc is very different to requiring life to be sustained as you are providing an option that reduces so many issues. Whereas you are challenging all of those processes to provide more support for longer and perhaps even after medicine might consider life has expired. I wonder if the OPG might reject the LPA as the requirement is:

The attorneys must always:

• act in the donor’s best interests

And doctors, solicitors and courts may all counter what you wanted as not being in your best interests. 

You don't currently have an attorney and without close family, who might be emotionally invested and share the same beliefs, who might be prepared to fight the establishment for you?

How would you know if they did or didn't?

My thoughts are probably all guff but as I said we should be prepared to address these tricky questions whilst we still have the capacity. 

Thank you for taking time to reply.

The Preferences & Instructions bullets that I listed are directly taken from the OPG Help section as to what you might like to insert in the PoA, so I wouldn't think there is a conflict given that they suggest them eg I would prefer to die at home is a Preference - if it is not possible to die at home then that means the Preference cannot be fulfilled, however if there is a choice about being at home to die, then the Preference is there to guide the Attorney re what the Donor would prefer to have happen.

You have no close family and being blunt nobody that sees it as essential that your lives are sustained. Yet you wish to sustain those lives even if you are unaware of your own being and you are suffering?
Our family is each other and we each believe we are essential to the other. I will follow my husbands instructions regardless of pain to myself and vice versa. At some point obviously medicine cannot help, at which time there is only pain relief left until the end. And of course I am very aware death is a given - that doesn't mean we give up now because there are only limited years left and nobody could care less if we live them out or not. We care...it matters to us. There is one Attorney for me and one for my husband ie each other. So providing we are not critically ill at the same time, then we are each there to advocate for the other. 

Re "acting in the donor's best interests' as I understand it this means Attorney's can't make decisions in their  own (the Attorney's) interests and that decisions should be made that follow the Donor's Preferences & Instructions as closely as possible even if the Attorney thinks they are daft and they would never choose to do that themselves. Basically as long as Preferences & Instructions do not conflict with each other and do not break the law eg Assisted Suicide is not allowed on an LPA, then they are accepted.

The OPG gives the following as valid and acceptable so I was looking for examples that might fit our wishes, whether short or longer term incapacity occurs : “- My attorneys must not consent to any medical treatment involving blood products, as this is against my religion.”
This Instruction clearly raises a moral question with those who don't share the same beliefs as the Donor, because a blood transfusion could easily save a life and not having one could mean prolonging an illness, meaning other more costly treatment is needed, or it could lead to a painful drawn out death. However, the OPG accept this Instruction as valid because it is the Donor's Instruction and it is not illegal.

The Preferences and Instructions sections of an LPA can include a whole range of things. Some further examples I have seen are as follows.
“I’d like my pets to live with me for as long as possible – if I go into a care home, I’d like to take them with me.”
“I would like to take exercise at least three times a week whenever I am physically able to do so. Whether or not I am mobile, I would like to spend time outdoors at least once a day.”
“I prefer to live within five miles of my sister.”
All the above are acceptable to the OPG.

I feel the responses to my post are getting caught up with morals and questioning the rationale, when what I was looking for is practical input. 
What have you all written in your LPA Preferences & Instructions sections?

Thank you again
x

silvercar

As this seems to be connected to your religious beliefs, do you have a religious leader who could help you with the appropriate words? You can’t be the first in your religion to have this decision.

” For religious reasons, my attorney must not consent to life-sustaining treatment being withdrawn even if for example I am in a persistent vegetative state or terminally in pain”

Consider whether your preference would be not to start a particular life-sustaining treatment to avoid a situation where it had to be withdrawn. I’m thinking of a situation where resources at a hospital were stretched and staff were unwilling to offer you some life sustaining activity if the consequence was they couldn’t remove it eg an artificial breathing device. 

You may also want to have a documented wish, that in the event of any potential dilemma, you would request that advice be taken from a named local religious leader or a certain position within your faith.

SKA123

silvercar said:

As this seems to be connected to your religious beliefs, do you have a religious leader who could help you with the appropriate words? You can’t be the first in your religion to have this decision.

” For religious reasons, my attorney must not consent to life-sustaining treatment being withdrawn even if for example I am in a persistent vegetative state or terminally in pain”

Consider whether your preference would be not to start a particular life-sustaining treatment to avoid a situation where it had to be withdrawn. I’m thinking of a situation where resources at a hospital were stretched and staff were unwilling to offer you some life sustaining activity if the consequence was they couldn’t remove it eg an artificial breathing device. 

You may also want to have a documented wish, that in the event of any potential dilemma, you would request that advice be taken from a named local religious leader or a certain position within your faith.

Thank you for replying. We don't have personal access to a religious leader because of where we live, however I also contacted some church forums online for their input. Unfortunately many people don't have a PoA in place, hence me reaching out here too as Martin Lewis strongly advocates having PoA's and I had hoped it might be a subject where there was plenty of experience to share.
You raise an interesting point in your final para, whilst there is nobody local or at least within 50 miles, it is definitely worth me following up this line of enquiry, so thank you for suggesting it.
x

Newly_retired

As a spouse who has been at the bedside of a dying husband, may I add to Silvercar's points?
My late husband was in hospital, dying of heart failure and other causes. He was given assistance with breathing. After about 20 hours we were told that his organs would soon fail as the heart was no longer able to pump blood to them. The breathing device would be turned off and he would die within hours or minutes.  The ward was busy ( three patients died that night ) and we were left with him for several more hours. The doctor returned and said it was time to turn off the device. We agreed ( and he died within minutes. ) Presumably you would not wish your Attorney to agree even then?

You do realise that once your Attorney has died, your wishes will not be fulfilled?

I am not interested in trying to change your beliefs, just to ensure you understand the potential consequences.

Keep_pedalling

The problem I see here is that with only one attorney, this is going to fail for at least one of you. Once your attorney has dies or has lost mental capacity, the LPA fails. For this reason you may as well leave that blank because while you have an attorney who is aligned with your own beliefs then they will do what has been agreed between you but once the LPA fails no one will refer to it so any end of life care decisions will be made by health professionals. 

Sea_Shell

Keep_pedalling said:

The problem I see here is that with only one attorney, this is going to fail for at least one of you. Once your attorney has dies or has lost mental capacity, the LPA fails. For this reason you may as well leave that blank because while you have an attorney who is aligned with your own beliefs then they will do what has been agreed between you but once the LPA fails no one will refer to it so any end of life care decisions will be made by health professionals. 

I was just going to say similar.

If you are sole attorneys for each other, what happens if either of you lose capacity and/ or die.

Who will then make all those "PoA" decisions that you've documented, if the PoA ceases to be valid at that point?

There will be no one to "fight your corner".

sheramber

If your husband agrees with your wishws  why do you need a POA.

You are sayong he cannot do htings that you have stated he agrees should not be done so  presumably he would not  agree to them.

or, do you not trust him to follow your wishes.

When my husand  went into the hospice  my GP asked me if he had made a DNR.

i cinfirmed he had not but had expressed that he did not want intervention.

I respected his wishes.

silvercar

sheramber said:

If your husband agrees with your wishws  why do you need a POA.

You are sayong he cannot do htings that you have stated he agrees should not be done so  presumably he would not  agree to them.

or, do you not trust him to follow your wishes.

I would say a PoA is needed for exactly this reason, otherwise medical staff can do what they think best or is standard practice rather than listening to the views of the next of kin.

silvercar

SKA123 said:

silvercar said:

As this seems to be connected to your religious beliefs, do you have a religious leader who could help you with the appropriate words? You can’t be the first in your religion to have this decision.

” For religious reasons, my attorney must not consent to life-sustaining treatment being withdrawn even if for example I am in a persistent vegetative state or terminally in pain”

Consider whether your preference would be not to start a particular life-sustaining treatment to avoid a situation where it had to be withdrawn. I’m thinking of a situation where resources at a hospital were stretched and staff were unwilling to offer you some life sustaining activity if the consequence was they couldn’t remove it eg an artificial breathing device. 

You may also want to have a documented wish, that in the event of any potential dilemma, you would request that advice be taken from a named local religious leader or a certain position within your faith.

Thank you for replying. We don't have personal access to a religious leader because of where we live, however I also contacted some church forums online for their input. Unfortunately many people don't have a PoA in place, hence me reaching out here too as Martin Lewis strongly advocates having PoA's and I had hoped it might be a subject where there was plenty of experience to share.
You raise an interesting point in your final para, whilst there is nobody local or at least within 50 miles, it is definitely worth me following up this line of enquiry, so thank you for suggesting it.
x

I think you are right to do it. I wouldn’t worry that what you are putting in a POA is outside the norm, the whole point of it is to have your views heard when you may not be in a position to state them.

I know the refusal of blood products or the decision not to mechanically aid ongoing life which would result in the need to withdraw it later would be included in a PoA.

sheramber

silvercar said:

sheramber said:

If your husband agrees with your wishws  why do you need a POA.

You are sayong he cannot do htings that you have stated he agrees should not be done so  presumably he would not  agree to them.

or, do you not trust him to follow your wishes.

I would say a PoA is needed for exactly this reason, otherwise medical staff can do what they think best or is standard practice rather than listening to the views of the next of kin.

The OP woiuld be better making a 'living will' which is a legal document expressing what she wants. 

If one party dies before the other the living will would still be in force where a POA would not be.