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I am my 82-year-old mother's durable healthcare POA. We've had the papers in place for years, but her doctor just activated it yesterday.
She submitted a letter in July to her medical file saying she no longer wanted any testing or medications. When asked about the letter yesterday, she claimed to have no memory of it. This set off the incompetence bells, and the durable healthcare POA was activated.


Mom lives in independent senior housing. She is diabetic. She has no interest in taking her oral medications. Her average daily blood sugar is 347.


I know her wishes. She just wants to be left alone and to live the rest of her time in peace. My role as POA is to make sure her wishes are honored, no matter what, correct?

Your mom living the "rest of her time in peace" means she will have one medical crisis after another that YOU will need to manage. It means you will need to move her to where she will get the proper care, and YOU will manage that. It means every time the NH or medical staff tells her/needs her to do something she doesn't like or doesn't want to hear she will do/say the opposite and YOU will have to confirm/convince/manage that -- unless you never plan on talking to her, visiting her or wondering if she's ok. My take on PoA is that it is a MUTUALLY agreeable arrangement that must work for BOTH parties or there's no point. It does NOT mean you are her lackey "no matter". Don't you want to have a life? Her "living in peace" just means she thinks you'll be constantly orbiting around her and protecting her from herself. I'm not sure why your mom is being an ostrich, but it will work against her "living in peace" every. step. of. the. way. Is that what you both want? Maybe revisit this topic with her once you read the insights from all those who have gone before you with parents who just wanted to "live in peace" but died in chaos.
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TXGirl82 Jan 20, 2020
nvm
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Correct.

She has put her wishes in writing, those need to be honored.

I guess you don't have to worry about the doctor anymore, I would ask for a hospice referral before you blow them off. If she isn't going to pursue treatment and that is what her living will states, that doctor can not force her to have treatment.

Best of luck, I am sorry that you are facing all of this. I think most of us will want to just go to sleep and never wake up and barring that, I personally don't want a bunch of medical interventions to keep me alive. I understand how your mom feels.
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Reply to Isthisrealyreal
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You would be correct. All you do is make sure her wishes are carried out. You can not over ride what she wants unless she is so bad off mentally that she forgot what she wanted then it really comes down to you to be her reasoning and her voice! Doing what is best for her!

Remember Drs are trained to save lives no matter what; therefore, you might find yourself going around-and-around with them, but once you say "no" to a Dr then he or she can not touch your mom. (That is the law).

I am sorry about your mom:( Good Luck!
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P.S. Any explicit instructions in the healthcare directive need to be followed. Any gray areas are up to you as your mom's agent.
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I am surprised at many of the answers provided here. I am approaching 70 and this past year I sat down with my attorney and revised my will, poa designations, etc. In the past 10 years, I sat on the sidelines because my older brother did not have these instruments. He experienced 8 years of dying one day at a time in a nursing facility, hating every minute of it. He was lucid most days but the facility insisted that he was mentally incompetent to change his medical decisions, and refused to share his 'condition' with us based on privacy issues.

Mom has ALZ. She constantly talks about being ready to die, ready to leave this world she no longer recognizes.

The idea that someone is potentially going to ignore my desires when my time comes is infuriating. There is a reason many Americans incur 80% or more of their lifetime medical cost in their last years...doctors and facilities make their livelihood keeping them alive.

Caregivers should respect their parents wishes. There is a huge difference between 'sustaining life' and 'prolonging death'. Suspect that most here would choose 6 months of quality time at the end vs. 6 years of 'existing' in a facility.

Will there be consequences? Yes. But as you described your mom, I am fairly certain, she knew that when she assigned her POA/medical directive. Ignore the 'advice' from some here to keep mom alive and do what she trusted you to do.

Prayers that she goes peacefully.
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Happyplace Jan 17, 2020
Thank you so much for posting this. I was riddled with guilt by a couple of people's comments when I carried out my Dad's wishes (which he had CONSISTENTLY expressed for at least 40 years,) even up until the last few months of his life. He NEVER swayed from what he had wanted. If the OP's Mom wrote her wishes when she was competent, then that is what needs to be carried out. The OP could definitely discuss the consequences of these decisions, in the event that the mom doesn't really understand, but at the end of the day, those wishes should be honored IMO.
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Wow is this timely! We took my frail 89 YO mom to the hospital yesterday.. multiple issues, but she is a retired RN and has had a DNR/DNI for years! While all the testing was going on,, the nephrologist ( I feel) bullied me into making her full code,, "for the time being and temporarily". I work in an ICU.. I KNOW how this goes,, once they are intubated you are screwed... So when we went in last night, in front of family and RN we asked her what she wanted. "None of that, just let me go" . Today in front of RN and 2 dear friends we addressed this again.. nope, she wants nothing. So the RN called the Dr and we had it changed. Mom was clear to her,, no dice! The Dr did agree then that with her smoking and her frailty she would not survive CPR, or ever come off the vent. So at least I feel like I am honoring her wishes, hard as it may be. Good luck!
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Reply to pamzimmrrt
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What is written in her Medical POA. My Moms read like a Living Will. If her's does, then you follow her wishes. The letter went into her Medical File and should be honored. That's 6 months ago. Her decline could have worsened in that time. My Moms did.
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Is her blood sugar ever in the 90 to 160 range? If is, ask her about this then, when her brain is at peak efficiency. The problem with not treating diabetes is all the horrible complications, which could develop remarkably quickly: vision problems, nerve damage, and even amputations. If she's ready to die soon, that's one thing. If she's ready to lose both feet and her vision, and live for another twenty years, that's quite another problem.
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thepianist Jan 17, 2020
You are right about the long-term consequences of untreated diabetes. But it's unlikely she will live another 20 years with untreated diabetes, to suffer those consequences. Pneumonia used to be called the old-person's friend, because it couldn't be treated effectively and took the a person quickly. My family member who had advanced dementia with a host of other problems, developed an infection which we did not treat (with the approval of a priest-ethicist), knowing he would not survive. He was kept out of pain and comfortable until his death, which was several weeks coming. This mother can be kept very comfortable while her diabetes takes over her body. It may sound gruesome but this is what this woman seems to want, or did when she was of sounder mind. Let's let her go in peace.
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Call in hospice and get a palliative care consult.
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Reply to IsntEasy
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Essentially, with sugars this high, your mother is entering a palliative care at least and hospice more likely situation. Essentially this is a death warrant, and the fact is that diabetes kills slowly and torturously. It is not often people die of the high sugar itself. It is more that it will slowly take out all major systems, likely starting with peripheral vascular, heart and kidneys. If you are certain that your mother understood that she was signing on for death (I might do the same) then you are free to carry out her plans and request palliative care and hospice. Wishing you good luck. A hard situation.
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