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MIL was admitted to the hospital, and it looks like she's had some strokes. She has been unresponsive since being admitted on Friday. Strokes were discovered through a MRI yesterday - bilateral, moderate on one side, and patchy damage on the other. There's an occlusion as well.


Doctors haven't come out and said it, but they don't seem to offer a lot of hope that she'll recover, the damage was significant - and they think that's why she hasn't woken up.


MIL has a living will that states no extraordinary measures, no feeding tubes or nutrition, DNR. My question is: Daughter has guardianship, can she have them put in a feeding tube or place her on a ventilator, overriding the Living Will, or will the doctors abide by the document over the "family's wishes"?

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UPDATE -

Good news is, the daughter has come to grips with the fact that her mom is dying. She asked her brother (my DH) his opinion and he told her that they needed to respect the living will - no feeding tube, DNR, etc. She then agreed. We are contacting Hospice today and will proceed. It will be sad to lose her, but also she is a shell of herself, that's not my MIL in that bed - it's what's left of her after this series of strokes ravaged her.

The more interesting news though, in talking with the nurse, she said that though the Living Will is important, the family had the ultimate decision -- YIKES! They would try to steer the family to follow the LW, if they know about it, but can't override the family's decision.

Bottom line - make sure your family (or at a minimum your POA or potential Guardian) are willing to abide by your wishes.

I'm sure "enforcement" of Living Wills vary from facility to facility, but this is how it would be handled at our local hospital. It just underscores what we say on here all the time -- have those talks with your loved ones, find out what their wishes are, make a plan, and make sure everyone knows the plan -- and do it now, while they are able to make these decisions and articulate them.
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Marcia732 Oct 18, 2020
We went through this in our family with two sisters having a bad time processing the bad news (We have to give him a chance) and the rest of the siblings where you are- do whatever you can if the end result is he recovers and goes home- (which was never going to happen.)

My friend went through this with a mom who had massive brain damage from the stroke and was never going to recover. She had one brother who needed more time to process and she felt that as long as her mom was kept comfortable (ie unconscious) there was no harm in giving him more time.

But it does seem that the person who is legally allowed to make your decisions gets to make the decisions. The paperwork is just guidance.
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I have never gotten a tattoo or piercing in my life, but am tempted now to have "DNR/NO HEROICS" tattooed on the left side of my ribcage where a medical person would have no way of NOT seeing it. I asked my sister to hook me up with her lawyer so I could do a POA and Advance Directive, because I absolutely NEVER want feeding tubes, amputation of limbs, intensive surgical intervention, etc. Leave me the flip alone, let me go if I am on the way out the door!
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calicokat Oct 18, 2020
That is actually a pretty good idea! It sure is one way to make your wishes known, and one would think it would be PRETTY HARD to miss it!

Donating organs is similar - you can put it on your driver's license but it's the family who will ultimately decide. In our house, I want to be a donor, Hubby does not. So we joke about -- if you want it your way, you better die second, cause he might not donate my organs and I just might donate his! LOL
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Do the doctors have a copy of the Living Will? I can tell you that they will do their BEST to talk the guardian out of doing the above.
Then it may go one way or another. As you have to understand the doctors do not want to deal with hysterical guardians claiming that they are allowing death when they should have/could have treated.
I think that the important thing here is that you make certain Doctor has the Living Will and that you THEN stay well out of it. If the guardian is FIGHTING and feels backed into a corner by you, then he/she will continue to flail madly without thinking on this. They will have an enemy to fight instead of the grief of facing this painful loss. The doctors and social workers and clergy can do much more good than you can.
You understand that this guardianship holds a lot of power. The guardian is free to say "Look, I spoke to her right before this happened and she told me 'I want to make out a new living will because I want to live, and I want everything done; my friend Hulda just had a feeding tube and she was right as rain in weeks'."
Leave it to the doctors and Social Workers and other staff to make the facts clear in a very kind and gentle way. I wish luck to all and and sorry for these circumstances. Hope you will update us.
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NeedHelpWithMom Oct 16, 2020
Alva,

When my mom was in a nursing home for rehab the social worker approached me about a ‘polst form’ to fill out. I had mom’s living will filled out and didn’t get around to filling out this polst form.

I don’t remember the details. Can you explain the difference between a living will and a polst please? The social worker said the polst was taken more seriously.

Is this a common form that is recognized in elder care?
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Thank you AlvaDeer -- always the voice of reason and good ideas!

I feel for the doctors, they get stuck in the middle of trying to do what's best for their patient and appease the family members as well. It's a no-win situation.

In my call to get the update last night, the nurse read from the chart that the daughter said "She doesn't want anyone talking about end of life, none of that!" and I'm picturing that it involved raised voices and a little hysteria already :(

And you are so right about me being the enemy - as an in-law, I'm already a second-class citizen to her. DH will make sure they have the document, and then we will step back (and I'll be two steps behind him even, lol.)

I expect it will be like you suggested, much flailing and fighting - and I understand, it will be coming from a place of fear and pain for my SIL, and I have great compassion for her. Any of us who have lost a parent know how hard that whole situation is, and how it breaks your heart no matter the circumstances.

Thank you for your input, it was really helpful!
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AlvaDeer Oct 13, 2020
I hope it gets well. Sometimes the person "in charge" such as the guardian scares doctors with "I will sue". She would not win, and docs know that, but they at times decide just to pretend they are treating, trying to calm and reason. I sure wish them luck. I have witnessed this many times. As they are documenting this they are already knowing they are going to have trouble, and they are already getting ready to address it. They have long experience and will do it over a few days to a week, if needed.
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I’m pretty sure a guardian can override a living will. Hospitals and doctors will ultimately defer to the person who has the ability to sue them instead of the person lying in a coma
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DeniseMiller Oct 18, 2020
If you have a GAL they are now your voice a person that has a GAL has no right anymore. Just because you have a living will doesn’t mean the doc’s will let you die. There’s a fine line of circumstance when a living will comes into play. Totally brain dead is when a living Will plays the role . Not just a bunch of strokes . It sounds like her mother still has activities going on in her brain they don’t let you die unless brain dead . But your right a guardian at litmus can totally make up your mind fir you. Depending on what the GAL was hired for. Some ate just hired for financial. Not totally hired to make all your decisions a full guardian takes the rights away from the person that was granted a GAL if the person can no longer make good choices or puts their life at danger then on is hired to live out your rights or if the person is being financially exploited or a family member or caretaker is taking total advantage of the person. It sounds like this person may want mom to die faster than it’s time that’s probably why a GAL was appointed here but excuse me If I’m wrong.
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No, she shouldn't be allowed to override it.

My daughter, RN, would not even recommend a feeding tube at this point. Its only prolonging the inevitable and can do more harm then good. Especially if the body is shutting down. I would ask for Hospice at this point. From what you wrote, this child should never have been guardian. She is letting her emotions override common sense.
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AlvaDeer Oct 13, 2020
I think only the guardian can ask for hospice, or the doctors recommend they do that. No doctor will recommend these treatments I do believe. But I think OP fears that the guardian will ask for heroic measures no matter what the person now unable to respond wanted. I think Doctors and Social Workers will be able to handle this, but I have seen it happen.
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I think this is a matter if timing. Is your MIL close to death? Is it imminent? Or are the feeding tube and vent interventions to help her recover? You say she's recovered from strokes before. If death isn't near, I think the procedures could be worth doing. If the doctors think she is close to death, then why would you want to deny your MIL her wishes? Sure, we all want our LOs to hang on but at what cost? Realize death is a part of life and we all have our druthers. Some of us will declare how we want to spend our last hours, some would rather leave it up to fate or burden the family with the final decsions. If these are her last days, how would it benefit her to prolong her death? How would it benefit the family?

If the family decides to override her wishes, you may have to live with the consequences of that decision, added expense, knowing you went against her wishes, watching her on a vent and other emotional scars you may acquire. Of course honoring her wishes could also result in "what ifs" by the family. I would want my children to honor my wishes.
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calicokat Oct 13, 2020
You raise some good points.

I'm headed for a visit in an hour, and I should have some good information from the nurses about MIL's condition and prognosis. From the conversations over the phone, it sounds like the situation is grave.

We would certainly be in favor of feeding tubes, etc. if it is short-term to help her heal and get stronger . . . or maybe even to "buy a little time", giving two out of town grandkids time to get to her bedside for their goodbyes. But she didn't want to get "stuck in a home, on machines" :(
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I am sorry that your family is facing losing your MIL. It is never easy and thankfully her daughter is coming to terms with the situation and not fighting for all measures.

God bless you all. May HE give you all strength and wisdom during this difficult time.
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First, the big question in my head is: do you want her to do that? Seems that other readers assume you don't. But maybe you do want her to. Knowing your goal affects how I think about your post. But I'll stick to the question asked.

Every time dad was admitted to the hospital the staff asked him about DNR and health care directive. His directive says no DNR but they ask whether he wants recessitation. He would always hem and haw about it; that he wanted recessitation if he could expect to recover fully. The doctors would then say there's no middle ground. If you don't say DNR then you get full recessitation.

In other words, the document is not the final story; not the final word.

It's good to have the document. But people need to be on board with what it says.

Also, the daughter seems to be denying the reality that her mother is dying. She's not ready to let go. That's unfortunate considering her position. Hopefully she will find the strength to let go.
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DeniseMiller Oct 18, 2020
You have to be totally brain dead in order for a living will to take place. Say you got shot in the head and your body was still Alive. That’s when the living will comes into place and or if you have a heart attack on the operating table thru will still try and recess you. It when they know for sure you can’t make a full recovery over a certain amount of time is when they won’t try a recess your life . Just because you have a few strokes they won’t follow through with the DNR they have to know for sure that recessive procedures will just prolong a body to live if the brain is totally dead brain waves have to totally be gone before they can ask the GAL or family what the DNR has in place . If you have a heart attack they are still going to try and save your life. If a doctor knows it won’t do any good to prolong your life fir the better then they follow aDNR just to name a few situations to mage people understand they just don’t let you go because you have one in place. There is the issue of suing the doctors and hospital so they must at least try. One crucial part of your body that keeps you alive must be totally dead before they let the DNR take place. When they know they are on the brink
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If she has a Living Will she probably has an Advance Directive, they are usually done together if an attorney was involved. Find out what it says in her Advanced Directive. A guardian or power of attorney should never willing go against the wishes of the person they are representing.

When they do it is often not because they think their loved one would be better with the feeding tube, clearly that is not what the doctor is saying. The problem more often than not is that the guardian or power of attorney can not let go of their loved one so they are insisting on the feeding tube. They are making decision based off what they want NOT what is best for their loved one.

I would contact a Elder Law Attorney and talk about challenging the guardianship so that your MIL shes are honored.

I am sorry you are having to go through this, keep us updated on any progress.
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calicokat Oct 18, 2020
You hit the nail on the head - SIL just wasn't ready to accept that mom wasn't going to recover from these strokes. She has made her peace with it, and we brought MIL home Thursday under Hospice care.

SIL is doing really well, she's appreciating these last few days with her mom, to talk to her and just be in her presence -- so the Hospice experience is going to be very good healing for her in helping her say good bye to mom.

Four of the grandkids have made it home to spend some time and say goodbyes -- one has said he prefers not to visit, he wants to remember Gr'ma as he knew her, not like this. And I respect that -- each one will handle it the best they can for themselves.
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