Discussion:Advance Directives for Health Care: Burn

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Discussion Forum Index --> General Chat --> Advance Directives for Health Care: Burn

CrowJD (talk|edits) said:

15 September 2011
I'm in a slow burn over these.

I don't know if it's in effect yet, but there is or will be a Medicare provision to allow doctors to be paid $125.00 to disucss end of life decisions with patients. I'm pretty sure it's $125.00.

From what I'm seeing, patients are simply being told that these Directives are required for the doctors' or hospitals' files, and then the patient is handed a rather thick form to fill out. That's the "counseling".

First, I want to tell everyone here that these forms are NOT "required". It may be a very good idea to have an Advanced Directive for Health Care, but they are not "required for the file". To suggest such a thing to a patient is outright fraud.

Second, these forms can be tricky to fill out and they must be signed properly. Again, from my experience when the patient is through with these forms, they are stuck back in the doctor's file with no review whatsoever, and the first time they are pulled out is if there is a problem.

By all means, make yourself a copy of this form before you turn it in to the doctor and read it again to make sure you've filled it out properly and that it's signed properly. If you have questions talk to a lawyer friend.

I suggest that people not be "hustled" into signing these forms without giving them some thought. Remember, most people are unconscious when these forms are pulled out of the file for use, and by that time, it's too late to correct one of these Directives. Ok, I'm off my soapbox.

Actionbsns (talk|edits) said:

19 September 2011
I'm not sure if it's worse, but it's just as bad. When a family member has to be in a convalescent setting, the decision makers are handed documents and told they are absolutely necessary. There are documents dealing with Do Not Resucitate rules and decisions, and they want them returned with a signature ASAP. But when you speak to the nurse or administrator in charge, you are told they are unnecessary and if you don't want to complete that part, it's OK. I've had this happen twice and both times it made a highly emotionally charged situation even worse. You just feel like if the family member being left in the charge of the convalescent hospital sneezes funny, or has some other relatively minor ailment, they just won't take care of them based on the DNR order.

I'm pretty sure that's not the intention, but it's really unsettling to have a ton of paper shoved under your nose and the DNR order is part of it. Especially when there is no counseling then in the end, it's not all that important anyway. There's got to be a better way to communicate.

CrowJD (talk|edits) said:

19 September 2011
Next thing you know you'll have hospital social workers handing out Wills and performing "estate planning".

Back when this whole idea started (with the Living Will) the idea of such things being signed in a hospital or after counseling by a doctor was discouraged. More steps were required to execute such documents in the hospital because it was felt there was a possibility of a conflict of interest.

Death&Taxes (talk|edits) said:

20 September 2011
When I lived in upstate NY, doctor's office had wife make a health care proxy which asked about heroic measures. She wrote to the effect that none to be performed if she were brain dead. This was her first visit to this doctor, a young man I really came to respect.

Within six months she was diagnosed with CHF; she died within two years of writing that proxy. What that phrase meant was that she had to be intubated and revived to see if she met her condition. Five times between Sept 13, 2000 and 6/14/2001 she was intubated. In February 2001, her doctor reviewed her choices with her; she did not want to change them. She thought her choice reasonable. In her last week of life, her pulmonary doctor told me intubation was a 'waste of medical resources. Sir, your wife is going to die.' Yes, he made me angry but I knew he was right.

On the night of June 13-14, she took off her oxygen mask apparently and passed, perhaps trying to put it back on.

CrowJD (talk|edits) said:

20 September 2011
I never had any problems with the Living Wills when that's all we had. The Living Will was a direction by the patient directly to the doctor or hospital.

The problems came in with the healthcare POA. As you folks know, an agent is appointed to make these decisions for the patient should the patient not be able to themselves. I've seen agents fall apart. It's a whole different world when they are actually faced with the decisions.

Another problem is that now my state (GA) has sort of a Frankenstein form where it has combined both the Living Will and the Health POA. It's like walking into a Baskin Robbins. There are too many choices and mistakes can be made in the filling out the form if the (future) patient is not careful.

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