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Spouse vs. MPOA and feeding tubes

Nurses   (2,902 Views | 31 Replies)

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tsm007 has 2 years experience.

675 Posts; 20,705 Profile Views

Pet peeve of mine, nurses who quote things as laws or policies and don't actually know where said law or policy is in writing. It's a 50/50 shot whether it actually IS a policy/law or not. I almost always find the dang policy in writing then put on my clipboard so when I tell someone this and they look at me like I'm stupid or wrong I can make a copy or hand it to them. I'd venture to guess that this "law" you are citing varies from state to state and challenge you to find the actual law for your state as a reference. Some states do have very specific laws so I'm not challenging you that you are wrong. I suspect you are right, but I think it's worthwhile to know the actual laws on this in your state.

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BSN16 specializes in ICU, trauma.

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Yes, it's very surprising to me. NGs are only used as a last resort to feed where I am. But the use of those and SBFTs is limited and not used long term due to the risk of infection to the sinuses. We very rarely use an NG to feed. NGs are used mainly for decompression where I am.

NGs rarely used???? what. they are safer than the other alternative-aspiration or TPN

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hawaiicarl has 28 years experience as a BSN, RN and specializes in Critical care.

327 Posts; 8,559 Profile Views

I am curious what state the OP is from where this is the "law" allegedly. Or is there some misunderstanding, the patient has an MPOA who is not the spouse who wants the tube kept in? If no MPOA is designated, then next of kin? I would not take this OP as fact in any way shape or form.

Cheers

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3 Followers; 4,704 Posts; 36,271 Profile Views

Yeah, and not only feeding tube. DPOA can turn your vent off as well, doesn't matter what your other dear and loving ones want to say about the subject. And sometimes it is something pretty much close to a blessing.

In LTACH where I worked, we pretty commonly had patients on chronic life support whose families were, to say the least, not quite adequate in their expectations. Sometimes the torturous "treatment" continued for decades while families expected some genius of medicine or, probably, the Lord himself to "finally fix' mom right up and made her like she was before" while pocketing mom's SSI checks in the meantime and often vehemently denying her pain meds and comfort measures "so that she would participate in therapy/see all of us here/know that we love her/etc." Once the business with that check became known (or things really went out of any semblance of control), the Powers brought the case to hospital's ethics commission which duly pronounced all further care medically futile. Family, of course, disagreed, and then the case was taken to Court which, using the fact that those families hardly ever took any care of "papers", appointed DPOA. Thus, patient became "the ward of the State", and the DPOA gathered the poor doctors second time for formal pronouncement of futile care. After that, patients were almost universally moved to comfort care/hospice. Believe me, for too many of them it was the first time in years when they were free of pain and unhuman suffering inflicted upon them by modern medical care and their "loving, hoping" families.

Some people really are loving and hopeful. You might never have met any, but they do exist. Is SSI supposed to stop when someone is incarcerated or institutionalized? If so, did you report to SS that a particular patient was institutionalized?

Poor doctors? Please.

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KelRN215 has 10 years experience as a BSN, RN and specializes in Pedi.

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The law is very clear that feeding tubes not be removed. Any other kind of tube, yes. And I suppose if the tube was causing tissue damage it would be removed-- and replaced in the other nare if possible.

Please cite the law.

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KelRN215 has 10 years experience as a BSN, RN and specializes in Pedi.

1 Article; 7,344 Posts; 68,599 Profile Views

They were using a NG for tube feedings for two weeks?

Why is this surprising? In peds, NG tubes can be used for feeding for months to YEARS (in the rare cases where the parent refuses a surgical G-tube). I literally send kids home on NG feeds every day.

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hppygr8ful has 15 years experience and specializes in Psych, Addictions, Elder Care, L&D.

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I went and looked to see what specific law you are talking about and couldn't find it but I did find several articles which state that the law is unclear who can remove a feeding tube. In many states the spouses wishes can be honored without the MPOA if the is compelling evidence that removal of the tube is what the patient would have wanted if they could make the decision for themselves. In which case input from other family members might be used or the opinions of two Physicians that the patient is brain dead and in a PVS. I agree that all adults need to have very frank discussions about their end of life wishes. That is why most P.O.L.S.T. documents have separate sections that address feeding tubes and other life sustaining measures. POA paperwork is easy to fill out and process. and should be done .

Hppy

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457 Posts; 10,229 Profile Views

My state has a similar law. Here's the actual wording in the statute:

"A surrogate who has not been designated by the patient may make all health care decisions for the patient that the patient could make on the patient's own behalf, except that artificial nutrition and hydration may be withheld or withdrawn for a patient upon a decision of the surrogate only when the designated physician and a second independent physician certify in the patient's current clinical records that the provision or continuation of artificial nutrition or hydration is merely prolonging the act of dying and the patient is highly unlikely to regain capacity to make medical decisions."

It defines surrogate as "an individual, other than a patient's agent or guardian, authorized under this part to make a health care decision for the patient."

It defines agent as "an individual designated in an advance directive for health care to make a health care decision for the individual granting the power."

The law also defines how a surrogate is to be selected if the patient has not appointed an agent. (Spouse, adult child, parent, adult sibling, etc.)

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13 Followers; 4,056 Posts; 31,489 Profile Views

My state has a similar law. Here's the actual wording in the statute:

"A surrogate who has not been designated by the patient may make all health care decisions for the patient that the patient could make on the patient's own behalf, except that artificial nutrition and hydration may be withheld or withdrawn for a patient upon a decision of the surrogate only when the designated physician and a second independent physician certify in the patient's current clinical records that the provision or continuation of artificial nutrition or hydration is merely prolonging the act of dying and the patient is highly unlikely to regain capacity to make medical decisions."

It defines surrogate as "an individual, other than a patient's agent or guardian, authorized under this part to make a health care decision for the patient."

It defines agent as "an individual designated in an advance directive for health care to make a health care decision for the individual granting the power."

The law also defines how a surrogate is to be selected if the patient has not appointed an agent. (Spouse, adult child, parent, adult sibling, etc.)

So that wording specifically allows it. It point blank states that the suggogate can make decisions except that in the case of feedings/fluids, those can only be withdrawn by the surrogate if two physicians agree (to state it simply).

I'm still not sure where the reported law about not removing an unused NGT would come from, though.

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457 Posts; 10,229 Profile Views

33;9585301]So that wording specifically allows it. It point blank states that the suggogate can make decisions except that in the case of feedings/fluids, those can only be withdrawn by the surrogate if two physicians agree (to state it simply).

I'm still not sure where the reported law about not removing an unused NGT would come from, though.

The law allows withdrawal of artificial nutrition and hydration if the nutrition/hydration are merely prolonging the process of dying. It would not allow it if for example the patient were in a persistent vegetative state. In the original post, the husband wanted to remove nutrition/hydration because "there was no hope of getting better." That is not the same as in the process of dying.

The statutes allow an agent but not a surrogate to withdraw nutrition/hydration if they think the patient would not want to live in that state.

There was a recent court case where the patient had not appointed an agent and the family & physicians wanted to discontinue nutrition/hydration, because their loved one would not want to live if there was no hope of a meaningful recovery. (Patient had had a heart attack and was resuscitated but never regained consciousness.) The family presented evidence to that effect. The lower courts agreed that the family's evidence proved the patient would not want to live like that but said that withdrawal of nutrition/hydration violated the statute and prohibited removal. Fortunately the state supreme court ruled that the evidence presented by the family was sufficient and allowed removal.

If the patient had a POA, it would not have been necessary for the family to go to court.

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13 Followers; 4,056 Posts; 31,489 Profile Views

In the case of my patient, they were dying, and tube-feeding led to fluid overload, so orders were given to stop feeding. However we had to leave the tube in, unused, and the spouse had to have their last memories be of that ugly tube sticking out of their loved-ones nostril while they passed away.

Actually the OP was about being unable to remove an NG tube that was not being used.

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Julius Seizure specializes in Pediatric Critical Care.

1 Follower; 2,243 Posts; 24,870 Profile Views

There was a recent court case where the patient had not appointed an agent and the family & physicians wanted to discontinue nutrition/hydration, because their loved one would not want to live if there was no hope of a meaningful recovery. (Patient had had a heart attack and was resuscitated but never regained consciousness.) The family presented evidence to that effect. The lower courts agreed that the family's evidence proved the patient would not want to live like that but said that withdrawal of nutrition/hydration violated the statute and prohibited removal. Fortunately the state supreme court ruled that the evidence presented by the family was sufficient and allowed removal.

If the patient had a POA, it would not have been necessary for the family to go to court.

What a horrible situation for that family :(

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