There's been an issue in the news lately that has caught our attention. A 95 year old woman, Mrs. Okada has been hospitalized at Queen's Hospital in Honolulu with a feeding tube attached. Her Advanced Health Care Directives state that she does not want her dying to be "artificially prolonged...and that her instructions shall prevail even if they create a conflict with the desires of my relatives, hospital policies, or the principles of those providing (her) care."
Mrs. Okada, however had granted her brother power of attorney in 1998 and he (and the family) does not want Mrs. Okada's feeding tube removed.
According to the Star Advertiser,
When my mother was having her Advanced Care Directive made out, I told her that either my brother or I should be given Power of Attorney so that we can make sure doctors will keep us in the loop concerning her care. She adamantly refused. I tried and tried to convince her saying that several relatives advised us that this was something she should do.
Nope.
Mom says that when it gets to that point and it's time for her to go, she does not want my brother or me to even think about holding her back. She does not want that responsibility in our power.
I haven't talked to her about this case because she'll probably tell me, "I told you so."
POSTSCRIPT 1: Art just said we're not quite clear on exactly what that Power of Attorney means anyway so we can't make a judgement on this case. Maybe that's why the judge is having such a hard time.
POSTSCRIPT 2: Art said there was another article yesterday that had more legal stuff about this case and how that end of life directive was amended after 1999. Whatever the case, Queen's Hospital has sent Mrs. Okada back to the nursing home with the feeding tube attached since the judge says it's going to take a month and half to make up his mind.
POSTSCRIPT 3: I've just reread the article in the Star Advertiser. It states that:
Mrs. Okada, however had granted her brother power of attorney in 1998 and he (and the family) does not want Mrs. Okada's feeding tube removed.
According to the Star Advertiser,
Two Queen's doctors then testified that they believe "beyond a reasonable doubt" that Okada will not recover after a series of medical problems, including a fall that left her with "devastating brain injury," followed by a stroke last year and a more recent bout of pneumonia that sent her from Hale Nani nursing home to Queen's on August 8th.Doctors say that if they remove the feeding tube, she will die in two to three weeks of a natural death.
Mrs. Okada's family say they see her eyes well with tears and she hangs onto their grasp when they try to leave her bedside at Queen's.This was all brought to court by Mrs. Okada's family. Judge Patrick Border says he needs a month and a half to make his decision. Queen's Hospital says in a month and a half, the whole question will be moot since she will probably die by then anyway. They feel the directive should be followed now and her wishes carried out.
Nope.
Mom says that when it gets to that point and it's time for her to go, she does not want my brother or me to even think about holding her back. She does not want that responsibility in our power.
I haven't talked to her about this case because she'll probably tell me, "I told you so."
POSTSCRIPT 1: Art just said we're not quite clear on exactly what that Power of Attorney means anyway so we can't make a judgement on this case. Maybe that's why the judge is having such a hard time.
POSTSCRIPT 2: Art said there was another article yesterday that had more legal stuff about this case and how that end of life directive was amended after 1999. Whatever the case, Queen's Hospital has sent Mrs. Okada back to the nursing home with the feeding tube attached since the judge says it's going to take a month and half to make up his mind.
POSTSCRIPT 3: I've just reread the article in the Star Advertiser. It states that:
Hawaii has no required format for an advanced health care directive, but the University of Hawaii Elder Law Program provides short and long form versions that people may use to declare their wishes. Both versions can be downloaded at https://www.hawaii.edu/uhelp/healthcare.htm.
if money's available they'll keep people alive until that ran out, in that order.
ReplyDeleteGosh this is so tough isn't it and very topical for our family at the moment. My daughter is a lawyer and has been hounding everyone in the family who is over 18 to get a Power of Attorney signed. The Health Care Directive, signed by the person's family doctor is also included as part of the Power of Attorney document here. You can choose to have different people to look after your health and your finances. However, the Attorney cannot change the written directive you give regarding your health anyway. I am surprised that your mother's wishes regarding end of life (if they are written in a legal document) could be changed by you or your brother if you were her Power of Attorney. Or does your mother just assume that will happen. Then again, maybe I don't quite fully understand it either. Glad you bought up the issue though as I will be interested as to what others have to say as well. Anyway it is somethign we should all have, young and old.
ReplyDeleteMy husband has my Power of Attorney, and I know he would never do to me what is being done to that poor woman. I hope that by bringing this question to light something will be done for her.
ReplyDeleteWhat a shame that the family is putting the woman through all that, and what a shame that the legal system just makes it worse.
ReplyDeletethis is very tough territory, tender ground, my mum was in the final stages of breast cancer, it spread to her lungs and liver and bones, she went to hospital three days before she died, i signed a do not resuscitate paper, we had arranged this before hand, my mum and I, , I cried while doing it but, my mother asked that she be allowed to die naturally and did not want to linger on , when it becomes a legal issue compassion goes out the door , sometimes,
ReplyDeleteWow you have opened our eyes. We have a Rev. Living Trust, a Last Will and Testament, a Living Will and each other's power of attorney but I'm not real sure about how our final wishes not to be kept alive by artificial means are protected. Think I'll go back and take a look.
ReplyDeleteI had no hesitation in allowing my mother to die rather than be dragged back to an existence rather than a life. We had discussed the whys and wherefores for many years and it was clear that she (and I) had no doubts how we wished to be treated if we became totally incapable of independent life. I feel for poor Mrs Okada - her final wish has been rebutted.
ReplyDeletedefinitely something to think about...
ReplyDeleteThat judge was super clever!
ReplyDeleteEveryone: if you want to minimize grief and trouble for your remaining relatives, PLEASE have an Advanced Directive and Durable Power of Attorney for Healthcare.
ReplyDeleteGo to www.caringinfo.org and read the information, and print off the forms for your particular state. Have it notarized in case such is needed in other states for when you travel. Keep the original. Make many copies. Send copies to your usual hospital, primary doctor, and any specialists you work with intensively for current care. Put a copy in each glove box of cars you use or frequently travel in. Shrink a copy and put it in your purse; men: shrink a copy really small and put it in your billfold. An emergency room/hospital can enlarge it.
Even if you have a regular will and have directed someone to take care of your finances, that does not cover healthcare decisions.
The Advanced Directive is a list of your desires to help families and doctors make medical decisions, in the event you could no longer make decisions.
The 2nd, separate part:
The DPOA is a person (make it one person,) who will try to get other family members and docs to do what you directed. They need to be a patient advocate for you, to fight for what you do and don't want to happen.
The DPOA goes into effect ONLY when the patient can no longer communicate IN ANY WAY, or is not competent to make decisions.
A DNR (Do Not Resusitate) is NOT something put in place with the Advanced Directive or DPOA choice. Only a doctor can write a DNR order, and it must be done with each hospital admission. For home care, hospice, or nursing homes, or ambulance transfers of a DNR person, a red and white "Outside the Hospital DNR" form must be filled out as an original and signed by the doctor.
By NOT having an Advanced Directive and DPOA, you ARE giving up your choices and allowing the medical community to do as they wish, or allowing a relative who does not know how to gather unemotional medical information, to make decisions against your desires.
By HAVING an Advanced Directive and DPOA, the DPOA can prove that when the patient was able and coherent, they were able to put their choices in writing.
Most docs will step back from such directions even if there is one family member going against the wish of the patient, and the doc will be very careful to proceed as the patient desired.
Sadly, I have seen many patients suffer and be "kept alive" because the family wanted to continue to receive the retirement or Social Security check into their household.
My son signed his first Advanced Directive and DPOA when he was 18. These documents can be redone as life events occur. Although it doesn't have to be the spouse, my son redid his after he married. I redid mine to have my son as my DPOA after he became 18, the legal age in which he could be named a DPOA. Most forms list a 2nd and 3rd DPOA, in case the 1st DPOA choice is no longer living or refuses.
After you've seen alot of cases, there ARE some things worse than a dignified death.
Many hospitals will be happy to mail you their brochure and forms for doing an Advanced Directive and DPOA. An attorney is NOT needed at all.
Having such forms prepared is the kindest and best gift you can give the people you love.
Please, do your homework and fill out your forms. Talk with your DPOA to give them an idea of what you do/ don't want. Then, you can enjoy your life, knowing that someone has been given the tools to fight the medical community for what you do, or do not want.
Aloha, DrumMajor (R.N. for 10 years, with oncology and hospice.)
Thank you so much for this information, DrumMajor!!! I love it! Art and I do have the Advanced Care Directives and DPOA, but we haven't given it to Tripler or have it nearby. You've motivated us to get that all in order. I'll have to go find it! Thanks so much for the heads up! We really really appreciate it.
DeleteWow...lots to think about. Thank you for bringing this to our attention and I am certainly going to have to think about this one. We had one made with our attorney about 6 years ago, but that was done in haste with a bunch of other legal work. Kaiser always asks if I have one and I said yes but never bothered to give it for their files. Oh why must life be so complicated...right up to the moment we die.
ReplyDeleteL. from W.
I don't know how a case could be any clearer than this one. The man with the Power of Attorney is clearly NOT carrying out his duty. His job is to do what the patient wanted done. I had Power of Attorney with my wife and we had discussed this issue many times over the years. Her wishes were clear: no heroic measures, no resucitation. By the way Power of Attorney also extends to checking accounts and stuff like that and, in my opinion, the final directive overrides the Power of Attorney.
ReplyDeleteSome people may hate me for this, but here goes: this stuff about the patient is responding and squeezing the hand and crying and stuff like that is all nonsense (I could use other words but I won't out of deference to the civil politeness charactrizing this blog) if the patient has had dementia, is unconscious, end-stage and fading out. It AIN'T happening. Some people see a so-called miracle where there is none whatsoever. They are just miracle-minded. And they report "success stories" that make them look good in their own eyes. I see it all the time in my Alzheimer's Support Group, as though they have peculiar abilities to heal and understand. This is very true in Hawaii because we have such a large percentage of mystically-minded peopple. So sue me if you don't like what I'm saying. I've been through it and I know what I'm talking about.
Clarification and agreement with Mr. Chapin --
ReplyDeleteYou are soooo right about some patients with end-of-life tears and hand movements. It is not usually what the family members incorrectly interpret.
But, since we were talking about healthcare Power of Attorney, the healthcare one does NOT include financial stuff like checking accounts, only healthcare decisions. Yes, most couples, probably like yourself, also have the "executor of the estate" and Power of Attorney over financial matters, which sometimes begins when the patient is unable, injured, ill or debilitated and cannot take care of their own financial affairs, even if they are still able to make decisions about their healthcare. Many times, older folks have one adult child be the healthcare DPOA and another be the financial Power of Attorney.
As you mention, and may or may not be the case with the Hawaii lady, unfortunately, it's very hard for a doc to do as an Advanced Directive lists when a DPOA overrides it. Doesn't happen too often though.
Glad you were able to help your wife as she desired. Condolences for your loss. Being able to exit this world as one desires takes alot of work, effort and love.
DrumMajor
DrumMajor--Thanks for your understanding. You're right about separation of Power of Attorney and Advanced Health Directive. This fact makes it all the more strange that the man with the Power of Attorney is overriding the patient's wishes. I guess it's the power of making a big stink that the family is doing overriding the doctors' judgment. I know Dr. Willcox and he is a first-rate guy. By the way, he is the author of a study showing that the Okinawan diet is conducive to long life, so he is friendly to the idea of a long and HEALTHY life.
Deletelots to think about...we do have power of attorney documents but not sure about a living will.
ReplyDeleteFor Christine and others: Your documents may only be for financial designates.
ReplyDeleteFurther clarification:
There's "Power of Attorney" for financial things, personal assets, property, usually designated in a Last Will or a Trust document, usually drawn up by a paid lawyer. This has nothing to do with end-of-life healthcare, and doctors don't want to see the financial papers/designates.
Then, there's a different "Power of Attorney" for Health Care. DPOA stands for "Durable Power of Attorney" for Healthcare. This heathcare attorney can be called slightly different things in different states.
It's "sister" document is usually a "Living Will" or "Advanced Directive" which lists or describes some general healthcare-only decisions to be used as a guideline to the docs and healthcare DPOA, when a person is unable to make healthcare decisions.
Not that I'm wealthy, but I have a Will, and Trust, which designates who takes care of my finances if I couldn't or can't, even before death, and what to do with property and assets after my death. I paid a lawyer to draw up these multi-page legalese documents.
I also have an Advance Directive, which describes, IF I'm not expected to have a good life as desired due to terminal illness or severe disability, AND can't communicate for myself, how I want the docs to treat, or NOT treat me. It is only one page. A lawyer is not needed to have one.
On the reverse side, is a one-page "Durable Power of Attorney for Heathcare" which lists my 1st, 2nd, and 3rd choices for a DPOA who will fight for what I do and do not want, IF I can't communicate for myself. A lawyer is not needed to have one.
Good luck folks. Please do your Advance Directives and Healthcare DPOA. It will keep you and your families out of the news.
DrumMajor
Good for your mother!
ReplyDeleteMy mother suffered a major stroke and was given a week to live. She was paralyzed and unable to swallow. A feeding tube was mentioned by her dr, however we knew she would not want that and said no. My brother faltered for a moment and then the dr said something that made us all glad we chose what we did. To remove a feeding tube would take a court order and is often seen as killing the patient. My mother would have been mortified. She did live for a month, giving us all time to spend with her and talk of what had been and letting her know we were ready for her to go on. We had no idea how much of this she knew, but we did know that she would not have wanted to be allowed to live like that for years.
After all this, I went to look for our Advanced Directive and Durable Power of Attorney. Would you believe the lawyer had written it out for us BUT we had not signed it yet or had it witnessed? Good grief! We'll be taking care of it now. Thank you everybody for your wonderful advice and input.
ReplyDelete