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 Need guidance Understanding POA role Health Care Directive 
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Joined: Sat Mar 27, 2010 6:15 am
Posts: 44
Location: USA
Post Need guidance Understanding POA role Health Care Directive
My dad's health directive says he wants no life support or force feeding.
The directive says he considers his quality of life below his wishes to survive if he cannot feed himself, take care of himself, or recognize family.

My dad already wishes he could die. He hates living with others taking care of him. He truly would prefer death to being incontinent. He is in pain constantly with his back, legs, hips. I understand my dad quite well and I know why he feels this way. I share the very same feelings about my own life. His being blind in the last few years has doubled this conviction in him.

He was very much a "mountain man" and even lived in a log cabin he built himself with no electricity or water. He always says "if I were an Indian they'd just let me go off alone to die" He also cannot see so he can't even enjoy watching his Westerns anymore.

My question is this what does "cannot feed myself mean?" if he decides to quit eating at some point and I support him can he be force fed? Can you force a person to stay alive? Especially if the doctor has determined the person has dementia? ( I think I can support dad's decisions but really don't know until it comes down to it) Could I as POA keep them from force feeding my dad?

I don't really see my dad ever turning down food while he can still swallow but if he does.... will he be allowed to?

Also his directive says "if I cannot take care of myself" which he cannot do now because of his pain, eyesight, loss of muscle tone and strength. His directive says he wants no life saving measures such as anti-biotics, surgery, etc.... Does this mean if he gets something that could kill him that I should refuse treatment with anti-biotics if my dad wants that?

Would he even be allowed to refuse to be treated if he got pneumonia?

It is all very confusing at this point.

Right now my dad is smoking cigarettes, and cigars like a stove. I believe he thinks this will do him in but I am sure it will only add to the decline. I don't try to get him to stop. Sitting in the "smoking room" with the other men is as close as an "okay time" as dad can have right now.


Sun Apr 18, 2010 3:11 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
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No one should ever be force fed. Your father can refuse to feed himself and he can refuse to be fed by others.


Sun Apr 18, 2010 3:26 pm
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Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3378
Location: Vermont
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These are all good questions, and ones I constantly think about and have to deal with too. You are lucky these things were written out by your dad when he was of sound mind. A few weeks ago when my dad had "stopped eating" I told his caregivers NOT to force feed him, that his body was probably shutting down. When I got there a few days later I ate 1 -2 meals with him every day. I'd ask him if he wanted to eat and he'd tell me yes or no. Every day I brought things from home that I knew he liked (devilled eggs, cheddar cheese, fresh strawberries, stuff from his favortite restaurant). As long as I was there with things he liked and helped him eat, he ate quite a bit. That told me he was not ready to die and was not choosing to stop eating and drinking. If he had refused his favorite foods and my assistance, that would have been a sign to me that he was shutting down. I would NOT have tried feeding him then, and I would have told his caregivers NOT to force feed him.
When it comes to antibiotics, this is a little trickier for me. His advanced directive is pretty clear about all the things he doesn't want to live with, but if he cut himself shaving and needed an antibiotic, would I want him to die from an infection? My answer as POA so far has been "give him antibiotics". If he broke a leg falling out of his wheelchair, again my answer would be "take him to have his leg set" and to make sure he's not in pain. But, if he has a heart attack on the way to the hospital in an ambulance to get his broken leg set, they have specific instructions NOT to do any life-prolonging interventions.
It is so individual, and we really have to ask ourselves over and over, if he were of sound mind and in this awful physical condition, what would he want? And knowing their minds are not healthy either makes it complicated. I am not in favor of prolonging life when people have these extraordinarily awful diseases (me included). That said, these are still complex ethical questions. As POA, we have the right and responsibility to our LO to institute the wishes they made in their advanced directives.
It was very clear to me when my mom was in a coma that she would have been very upset to know she was on advanced life support. I asked the dr. to to an EEG to see what her level of brain functioning was. I asked them to take her off the life support after seeing the EEG and talking with several drs., but because my father was her POA and wouldn't do it, we had to let her die of a heart attack a few days later. Hers was a clear case (for me) because she was so adamant about Slow Medicine, not wanting to "live" in a coma on life support or under other conditions. She was all about quality of life, not quantity. Not everyone is so clear or direct.
This topic is discussed in a few other places and you may want to read them to see what others' thoughts are. If you look under Treatment Options, there are 2 recent topics "Slow Medicine" and "Saving their Lives" where there was quite a bit of discussion this winter. There are probably other older postings too about this topic.
Some people's philosophy is that by instituting the statements in the advanced directives, we are "playing God". Doesn't the medical profession do that every day? Medicines, surgeries and other procedures change the course of people's lives all the time. I personally don't think that letting nature take its course when a person has a horrible, untreatable, terminal illness is "playing God". I think it is letting nature take its course.
That's my 2 cents, more like 2 dollars! Sorry this is so long, but it is a topic I do think about every day and wrestle with decisions about all the time. Lynn


Sun Apr 18, 2010 4:47 pm
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