[lpnflorida]

I have an advanced directive and medical proxy. I chose to have my best friend who is an RN be that person .After many hours of our discussing point by point several different scenarios she has a clear understanding of what I would want.

My rationale was I knew my daughter would have difficulty letting go. I wanted to spare her having to make a difficult decision. I did not want my other family members to get at each others throats if they disagreed with my wishes.

My best friend in many ways knows me best, the bonus she would not beyond the day of my funeral ever have to see or deal with my family again.

[woody62]

I have a Living Will and a Health Care Proxy. My daughter is named as my proxy. She and I have had numerous talks about what I want done if I am no longer able to voice my choice. I have also discussed this with my PCP, who is aware of my feelings and directives and has agreed to them. One point, if the health care proxy is not a relative, there is a chance that that person will be ignored. Family members are given a louder voice then a non-relative health care proxy.

Woody

[mama_d]

Where I work, years ago, we had a similar situation. The intensivist ended up dragging the daughter into the room while we were coding her mother...she was trying to hide out in the hall to avoid seeing what was going on. The doc talked her through everything that was going on..."She's been down for thirty minutes, no oxygen has gotten to her brain, she will be unable to recognize you..." Etc. Finally, when she said "Do you hear that sound? That's your mother's ribs breaking while we do compressions" the daughter decided to let her go. After we had put the poor woman through hell.

It's one of the worst aspects of nursing IMO. Unfortunately once the patient cannot speak for themselves the POA has all the power, even to override living wills. We do usually get a multidisciplinary team involved in circumstances as extreme as those described in the article, but some docs and nurses are more proactive than others in doing so.

[woody62]

When I first started in nursing, we had an ethics committee to decide when to take a patient off a ventilator and DNR him. Unfortunately, it seemed the committee took more time then the patient did to decide to die. I have informed my daughter her failure to follow my wishes will result in a life long haunting of her, after I die. She is well aware of my wishes and has promised to follow them. We have had many open discussions on the process of dying. And the terror of a relation attempting to make-up for old mistakes, by keeping a love one alive.

Woody

[LovingNurse]

We remind patients filling out AD and DPOA paperwork that selecting their DPOA is a huge decision because it really, really needs to be someone who they feel they can trust to honor their wishes. They need to know that their DPOA could overrule their Advance Directive in an emotional moment.

Grief, sorrow & fear can blur the thinking of even the strongest family member in an emotional situation or moment of panic. I was taught how our careful wording can really make a difference sometimes.
Remember to say to the family things like "What would your MOM (etc) HAVE WANTED us to do?"
Rather than asking the family "What/How much do YOU want us to do?"
Asking what the patient would have wanted takes the burden off the family. Once their family or DPOA can say the words like "mom would want to be let go" or "mom wouldn't want to live like this" then the medical team can let them know that they will respect their mom's wishes, etc. without it ever sounding like that family member said to stop the code, etc.

Sometimes we can say and do all the right things and nothing helps but I tell myself not to be too judgmental... End-of-life issues are so raw with emotion. We can't really blame anyone for clouded thinking, we just do the best job we can for our patient and help the family through one of the worst scenarios they'll ever encounter.