Can my MIL's guardian override her living will?

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.

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!

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.

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.

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.

I think the Nurse is wrong. There is a reason someone has a living will. Why they have a medical POA. To carry out the wishes of their LOs. Why have them if your wishes are going to be overridden.

The nurse isn’t wrong about the living will and the family. Drs aren’t required to follow living wills 😉.

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.

What is the purpose of having a living will if it is not going to be obeyed by?

It is the "patient's wishes" not someone else's. The patient could have religious reasons.

Then again, nothing is obeyed by these days.

This scenario is exactly what I learned in a class about estate planning. The guy who taught it said it's imperative that you select as your POA someone who isn't emotional and can make the tough decisions. He said his mother was absolutely the worst person to be his father's POA, and she kept him going for three weeks after he had his stroke before she finally let go.

Your sister-in-law is a guardian, so your MIL didn't choose her for the job, but there's another good reason to have this stuff lined up before you need it. She, too, is grieving, and the doctors and nurses have been there, done that a million times. They're good at guiding the family to do the right thing.

A living will really isn't a legal document. It's a statement of your wishes, so one would hope the person making the decisions would respect it, but it also doesn't mean a doctor would not treat a person for a survivable incident regardless of what the family or the living will say. I think that's why people tend to freak out at the "don't use any extraordinary means" idea of a living will, but there's no law that says it has to be followed.

A POLST seems to be used more in a nursing home than by someone at home making the decision themselves. They're really for someone with a chronic condition that's heading toward its conclusion, so paramedics, for example, don't walk into a house and start doing CPR on a person in the end stages of cancer who has died or is very close to it.

My mother never had a POLST until she went into a nursing home, but she didn't sign it -- I did. She was in the hospital this past weekend, but there was no discussion of letting her die because she has a leg infection and only needed a big dose of IV antibiotics. When I got to the ER, I gave them my POA that also had her advance medical directive, but the nursing home didn't send a POLST with her in the ambulance.

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.

If the Dr's and Hospital have a copy of it, they should abide by it.

YES.
Living wills are not written in stone and can be changed.

Just to answer a question asked by NeedHelpWith Mom, POLST = Pennsylvania Orders for Life Sustaining Treament. (MOLST, FOLST, etc.) This is filled out at the hospital on admission and becomes part of the patient's record. If the patient can't do this the person with Medical POA can. This makes the patient's wishes part of the record, but is more easily changes with circumstances than re-writing the living will. It is also a legal directive for the hospital, unlike the Living Will, which is a directive for the family.

A POLST is a document used by EMT's and other medical personnel. It specifies what to do for emergency medical treatment and must be followed by emergency personnel. It is a doctor's order and is signed by a physician. In my state of Oregon, it is one of the things that all physicians, hospitals, and skilled nursing facilities have asked for every time dad enter's the hospital. They are bright pink and we used to post it on his refrigerator when he was in his house. When he completed it a number of years back and in better health, he wanted FULL CODE which means to resuscitate no matter what. After a recent hospitalization and surprise from everyone (I've heard this many, many times before) as to why he would want to be resuscitated when he is in his 90's, they let me change it as his guardian.

A living will is not a doctor's order and therefore, cannot tell EMT's and other medical personnel what to do. It dictates future decisions about medical treatment. You are also able to appoint someone to make medical decisions on your behalf.

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

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.

Well, then. A living will is like everything else. Not worth the paper it is written on.

Just like a guardian. (useless) All it's about is a name on a piece of paper. Does not mean a thing.


How sad.

The doctors will still try anything to save her life it’s when it is an emergency accident and they know she or he won’t make it is where the living will comes in to place. Her having a few strokes won’t play a roll until the doctors know for sure that she will pass coma state. It’s when someone is at the stage of life support is when the living will comes in . But to starve her at this point they won’t do that they think she still has a chance. And she can still live comfortably. They just don’t let people die because of a living will the doctors and GAL can get sued for just letting her die. It’s medical circumstances on a living will you might want to read on the web what medical role plays in to a living will that may help you understand a little better on. Living will no when they draw the line.

Wow, tough situation and good question.

Strokes cause swelling in the brain. You don't really know where you stand as far as deficits until swelling in the brain goes down. Most care for patient after stroke is to reduce that swelling, control blood pressure and risks for future strokes, meet current needs, and provide rehabilitation for poorly functioning areas of the brain. If your loved one is not expected to survive this stroke, doctors will do several tests to make that determination and the majority have to show there is no upper brain function.

As for which takes priority: medical POA or advanced directive/living will... that is a thorny issue. It will depend on what each document says, your state/province's rules, and where the conflicts lie. Generally, advanced directives should take priority since this is the person's own expressed wishes. Person with medical POA should abide by the person's expressed wishes as well. However, individual emotions and individual expectations come into play and that doesn't always line up with those documents. Please notify the hospital so that their lawyer or medical ethics team can set up a meeting. Make sure that all adults that have a stake in your loved one's health are present. Let the hospital mediate the meeting. Please abide by the actions or plans that are decided upon.

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!

calicokat: I did see your update from October 14, wherein you state that your DH's sister had spoken about the matter. I am so sorry that your MIL is quite ill. An individual's Living Will is put in place by said individual and should be followed. Prayers sent.

These are her wish’s and need to be respected, regardless of “your” feelings.
Sorry to be so blunt, but she put this in her will for a reason.
Also, step back and truly access the situation, is hooking her up to artificial means going to give her a quality life? Doubtful. Let her pass in peace, the way She wanted it.
This is also in my will and anybody who ignores it I will haunt for the rest of their lives! DNR means DNR period.

No she can't

Are the doctors aware of her advance directive? If they are not aware of her advance directive they can, and probably will, apply at least some measures like inserting a feeding tube. If daughter has guardianship, she surely must be aware of of her mothers advance directive.
BUT it seems likely that she doesn't understand, or cannot face, the very poor prognosis her mother seems to have.
The doctors should have a frank conversation with her, especially if mother's future is a grim as sounds like it may be. Perhaps you should suggest to the physicians that they do so...let them know about the advanced directive and the daughter's hesitancy to enforce it.