Has anyone ever been a legal health care representative for someone

[Nurse Ratched, RN]

particularly for a non-relative (altho any experiences would be welcome.)

Case: Older gentleman, somewhat estranged from family, social friend (non-work - no ethical dilemma as far as overstepping the boundaries of a nurse-patient relationship because there isn't one.) Multiple medical conditions, currently in the process of downsizing his home to move to an apartment, etc. No money so no accusations of golddigging lol. As a friend, I've been helping him out with translating doctor-speak at appointments, small chores around the house that are not possible for him to do because of his health and the like. I brought up the idea of living will and health care rep after he was recently hospitalized. He has stated he does not believe his adult children would follow his wishes and wants someone who would to be designated. Several days later asked me to do it.

While I don't happen to agree with his wishes, that's irrelevant. He has explained them to me and I would definitely assert his requests if the time came.

Have you ever been in this position? I'm leaning towards yes. What are the pitfalls? As nurses, I believe we may find ourselves in this type of situation more frequently than the rest of the population because we have some knowledge of the health care system, so I'm hoping for some advice.

[Altra, BSN, RN]

Very thoughtful of you to consider doing this. :)

If this arrangement comes into being, I would think it would be very important for this gentleman to communicate it, in writing, to each of his adult children and all other significant family and to very clearly explain to his MD what the family dynamics are. I don't know the "ins and outs" of this, but could the physician even document that he/she has assessed this man's mental competency, just to be absolutely clear that he has made the decision independently?

[lsyorke, RN]

I've never personally had this experience, but it's come up at work quite a few times. The "my kids won't carry out my wishes" is a common reason. We've never had a problem as long as we have the paperwork to support the decision. I could see the "kids" not being happy about the decision, but hey, it's not their decision to make. Good for you!

[sgent]

If his wishes contradict those of his family's, and he gives you the POA, it could get ugly. Under that scenerio, you face a heightened duty of care compared to a medical layman due to you knowledge, and you potentially could face malpractice or negligence charges.

Given the above, I would definately talk to your attorney before accepting this. I would also make sure you are covered by a personal malpractice policy, or are an additional named insured in someone elses policy. Talking to his attorney could be beneficial as well, making sure you have access to his money if you need to defend yourself or him against action by the family.

One additional factor (not an issue here), if your have a patient/nurse relationship with this patient, many state laws would invalidate the entire POA.

[P_RN, ADN, RN]

Yes I have been in that position berfore. Mama tried caring for Daddy at home but never realized how sick he was. I got on the phone and called my neurologist, who said to bring him to the office stat. Within an hour he had a cerebral angiogram that revealed a lung met to his brain that was large as a baseball. He an I had long conversations over many many years about our wished. He didn't want to end up like his friends child, in an iron lung to breathe, unable to read d/t excessive fluid and O2 therapy. Mama and my two sisters met and I told them what chances were. The neurol. earlier had confirmed what I thought. It was decided DNR. He went to sleep and less than 15 minutes since I got home, there was a call from the hosp. telling me he had a grand mal and the NS wanted to talk.

He felt that debulking the tumor would give him more comfort. Again Mama and the girls looked to me. Daddy slipped into a coma that day and never awakened again. But he talks to me at times, and reminds me of funny stories. He's been good with my genealogy....he was a doodler and once you saw a pattern there was a family tree somewhere there.

Yes I miss him, no I wouldn't have traded him for another in a billion years.

[Nurse Ratched, RN]

Thought I would update that we did set up the HCR paperwork and tuck it away until/unless needed. Interestingly (and I don't know if this is a regional thing) the advance directive packet recommend you put the original in your freezer because "It's fireproof, most homes have one, and it's where the paramedics will look if called to your home." Are paramedics really checking freezers for advance directives in other parts of the country? I just thought that was wild.

Given my utter lack of any professional relationship with this gentleman, I opted not to concern myself with any potential increased exposure that might come about due to the fact that I happen to be a nurse. I don't think I'm going out on much of a limb and am willing to take the heat in the off-chance the worst situation would arise.