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I go to all of my MIL's appointments with her. She is in independent living with extra home-health support. She has been hospitalized twice for kidney-failure brought on by dehydration. She is currently physically healthy, but recently had a mammogram to check out a breast lump. While at the radiologist, I realized that if she had been diagnosed with cancer, treatment may not have been the best option at this point (and she still could make the decision at this point.) I want to have a conversation about how she would make decisions about things like dialysis or chemo, not just DNRs. (We are both her designated POA, but I take care of her health for the most part.) What resources should I seek to help me with this conversation?

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meness, this is tough for anyone. Since your mother-in-law can still make decisions, she absolutely needs a health directive (Power Of Attorney) for health. I wouldn't lay it all on the possible results of this test but you might find that if you open the topic with "what do you want done if it's cancer" she may tell you. Often our loved ones are waiting for us to ask.

If this is cancer, the doctor should inform her of the need for this document. So, if she won't open up to you and get this started, then send the doctor a message that she is balking at the idea and she needs his or her input.

The fact that she's had serious health issues before should make it obvious to her that she needs someone to speak for her even if it's for a short time. Make it plain to her that she can change the document at any time but that everyone should have this done.

If you and your husband haven't had your own health directives drawn up, you could let her know that both of you are doing this and she could go along with you if she'd like.

Good luck to you. I hope that you'll check back with us when you have time.
Carol
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Is she still competent to sign a Healthcare Directive? Making end of life decisions is complicated and involves processing a lot of information. Are you sure she is able to do that? Has she shared her feelings about it before?

I would read as much as possible. You can research on line like "dementia end of life decisions." I think the Alzheimers site has a lot of information.

You might also look at Palliative Care. Which is keeping the patient comfortable, without a lot of tests and treatments. My research provided me information about how the American Cancer Society stand on cancer screenings for people with terminal illness like Dementia. I'd read a lot about the myths and facts of tube feeding and artificial hydration and how CPR may be quite harmful for a terminally ill patient.
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First, check to see if your state requires you to have a Medical Power of Attorney. This will prevent any confusions when or if she would become incapacitated and gives you more access to her medical information. As far as a discussion, just start talking about what she would like in the event of...we all have to die, so this is not going to come as a surprise to her. She might welcome the conversation so she knows HER wishes will be carried out.
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I had a conversation with my parents at dinner about 10 years ago to find what their expectations were as far as do not resuscitate, ventilaors and dialysis and they were very receptive. When my father had a major stroke at age 86 my brother mother and I were in agreement on his wishes. This was without anything written down on paper. My only concern is that if there is no medical proxy, doctors will ask the closest next of kin which will not be you but your husband or his siblings who will also be on the same page.. Make sure that he is included in your conversation with your MIL.
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This type of conversation is very hard to do on your own. You can ask her doctors to assist but many of them lack the training or inclination to do so. A better approach is to invite your mother to work through one of the existing tools meant to guide older adults and families through these conversations. I recently reviewed these for one of my own articles on advance planning and here are three I like:

developed by a fellow geriatrician who has done a lot of research on advance planning. It is free online, and uses videos to walk people through the important issues they should consider.

Another one I like is the American Bar Association's Toolkit for Advance Healthcare Planning. It's a PDF workbook; I recommend printing the whole toolkit and helping your mother go through it.
americanbar

A third option is the Conversation Project's Starter Kit. This is less comprehensive than the other two, but better than nothing:
theconversationproject

Last but not least, you can try 5 Wishes, which creates an advance directive valid in 42 states. (costs $5 to buy/download the form or do it online) agingwithdignity

Now is definitely the time to help your MIL think through these issues. Good luck!
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Just sit down and say; MIL (insert name here), what are your wishes concerning -------. It is a shame it wasn't done years ago. I was the one to tell my dad he was terminal, I was there when my mom got the news she was terminal. We had already talked about what they wanted, where they wanted to be buried, what about Cremation, and everything else. I found out my dad wanted to be buried in a little cemetery I didn't even know existed. While I am at it, if you have family, do they know what you want? We are redoing our trust and I have made sure my kids know what I want. My husband and I not only verbalize what we want but we make sure others know and we have written down instructions. That way, our kids aren't left wondering.
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I can speak from experience to this question, as I've walked in those shows. Most, if not all the anxiety you may be having is all anticipatory. I have found that simply being direct but empathetic works. I would recommend while at the Dr.'s office during the appointment or on the drive home asking her if she has her Five Wishes completed (advance directives). If not, offer to help her with them. Share with her that you and her son want to follow her wishes, not the medical communities or anyone else's, but in order to do this she needs to provide you with a road map. Then, let her know that you are here to speak for her when she is unable too, therefore she needs to help you, help her. Good luck - pls let us know how it goes.
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We have the legal stuff in place, but it doesn't really deal with intermediate choice making. The wellness person at her independent living place gave me the 5 wishes packet. I think that is what I was looking for. She is also going to help us if we need it. Thanks for the input.
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