Brother is POA of medical and is not taking care of Mom and Dad's medical needs. What do I do?

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They live in an assisted living facility and Mom is able to make day to day decisions but not medical ones. Dad has alzheimers and can't make any decisions. My brother who lives out of state, and is usually out of country is their POA. My sister and I live near them. I have 30 years of medical experience and have tried for 10 months to convince my sister and brother that Dad's pacemaker needs to be checked. It has been going on 2 years now. They are doing nothing! I talked to my sister today and she said, "Well Dad is getting old." Unbelievable!!! I don't know where else to turn or what I can do. As far as I am concerned that is straight up neglect! Any help is appreciated.

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RM17, I noticed your thread because my 90 year old mother also has a pacemaker and the issue of battery replacement was being discussed recently on a BBC Radio 4 programme called "Inside The Ethics Committee." It made, er, interesting listening - if you look it up online on the BBC website it might still be available, I'm not sure.

The current situation is that my mother's pacemaker is checked every six months. It used to be annual, but for technical reasons she's running through the battery more rapidly than normal. So before very long, we'll be looking at a choice too. To replace, or not to replace.

Well, now. Like you, I assume anyway, I would tend to be in favour of replacing the battery. It's surgery, but it's minor and at the moment at least she would be able to follow what was going on and comply with the team's instructions. On the other hand… she has dementia. She has advanced kidney disease. Her heart function, even with the pacemaker, isn't worth toffee. If, when the time comes, her quality of life has deteriorated further and her cardiologist tells me it is not the right thing to do, I'll… well, I'll think very hard about it.

So I think it's a mistake to jump to conclusions. Step back and think about your father's best interests overall. Of course, I don't know what condition led to his having the device implanted: it could be that not having it will have a more direct and immediate impact on his health than would be the case with my mother. Also, you don't say how old he is, or what his physical health is like. I'm not pretending that I know the answer for him.

But before you choose this battle with your brother, think it through. You take him in to see the cardiologists for a check-up, fine. I agree that all information is worth having! But the next step is not so straightforward. Suppose they think that the device requires maintenance? There could come a point, perhaps, where that is not going to be the right thing to do.

Or are you concerned that the pacing might need adjustment? If there has been a worsening of your father's physical symptoms, then I'd suggest taking that up with his doctors if your brother won't act on it - you don't need POA to report symptoms, after all, only to decide on what course to follow.

I do appreciate how stressful it is when you find yourself in conflict with others over your parent's treatment. Try to detach from your brother's distance and your sister's apparent indifference and keep your eyes firmly on what is, truly, in your father's best interests overall. Best of luck.
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No. They have a living will to not use excessive measures. But no having a battery checked on a pacemaker is crazy.
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Do your parents have advance directives that perhaps say no more intervention?
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