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GeorgeK
03-08-2011, 08:19 PM
The abortion thread and the end of life thread got me thinking. In a scenario where you are the patient and your own opinion is not allowed to be known by the the person making your medical decisions, so it has to be a proxy consent situation, what are the odds that that person should use to make their opinion on whether to pull the plug or abort you? Poll is anonymous and should aloow multiple responses.

kayleamay
03-08-2011, 08:33 PM
Well, I haven't worked out a mathematical formula, but my husband knows that if my brain is damaged, pull the plug. A brainstem and a heartbeat don't make a life. And I don't want to waste away in a hospital bed. At least that's my view. If he goes before I do, I hope I don't end up with a POA that will force me to stay alive at all costs.

Devil Ledbetter
03-08-2011, 08:37 PM
*Backs slowly out of thread rather than risk bannination*

BjornAbust
03-08-2011, 08:38 PM
I'd want to retain at least 75% of my functions. If it's anything less than that; if I can't clean myself up in the bathroom or feed myself then, well, what's the point of living? I'd hate to be a burden to the people I love and, frankly, I've got a little too much pride. I can't stand the thought of wasting space on this good Earth as an invalid or, worse, a vegetable.

LOG
03-08-2011, 08:39 PM
Well, I haven't worked out a mathematical formula, but my husband knows that if my brain is damaged, pull the plug. A brainstem and a heartbeat don't make a life. And I don't want to waste away in a hospital bed. At least that's my view. If he goes before I do, I hope I don't end up with a POA that will force me to stay alive at all costs.

Well, after I die I don't care what happens, and brain-dead is death in my book. I will not care anymore.

kayleamay
03-08-2011, 08:41 PM
Well, after I die I don't care what happens, and brain-dead is death in my book. I will not care anymore.

I care because I don't want to be a burden to my family, or anyone else for that matter.

Alpha Echo
03-08-2011, 08:45 PM
Well, I haven't worked out a mathematical formula, but my husband knows that if my brain is damaged, pull the plug. A brainstem and a heartbeat don't make a life. And I don't want to waste away in a hospital bed. At least that's my view. If he goes before I do, I hope I don't end up with a POA that will force me to stay alive at all costs.

My husband and I have the same understanding. Neither of us wants to be a burden for the other, nor do we want to be physically alive while emotionally or physically (or both) unaware of that life we can't take part in.

regdog
03-08-2011, 08:46 PM
We already have health care proxy forms for this scenario, and my Aunt and I have discussed it at length. We both have stated that in the even one of us suffers illness or brain damage to the point of incapacitation, ie. unable to feed ourselves, care for ourselves, irreversible coma, we want the plug pulled.

Shadow Dragon
03-08-2011, 08:55 PM
I said fifty percent chance of normal function and moderate disability (like paralyzed from the waist down or losing my sight) would be acceptable. Any greater disability or the chances are less than 10%, then the plug should be pulled on me.

Bartholomew
03-08-2011, 08:57 PM
If I can't write or talk, kill me. I'm an extrovert. I'd rather be dead.

Vince524
03-08-2011, 09:10 PM
If I'm just a funtioning body with no mind, then I'm gone. But I would want to live otherwise.

Magdalen
03-08-2011, 09:44 PM
The abortion thread and the end of life thread got me thinking. In a scenario where you are the patient and your own opinion is not allowed to be known by the the person making your medical decisions, so it has to be a proxy consent situation, what are the odds that that person should use to make their opinion on whether to pull the plug or abort you? Poll is anonymous and should aloow multiple responses.

Could you please rephrase this question in standard English?

scarletpeaches
03-08-2011, 09:47 PM
I have no fucking idea what the OP means either, Magdalen.

What I will say is: I have a living will, and have done since I was in my late teens. Next of kin or anyone else's opinion doesn't come into it.

GeorgeK
03-08-2011, 09:47 PM
Could you please rephrase this question in standard English?

A stranger is making the decisions for you. What do you hope that they will decide for you?

Cyia
03-08-2011, 09:51 PM
I think he's asking if your next of kin doesn't know what you want, then what are the odds their own moral code will have them follow your wishes.

There are too many variables there to make a determination. Your feelings, the medical, proxy's, the presence or absence of DNR orders, if the incapacitation is to a minor, in which case the state can step in to protect the patient's rights...

Cyia
03-08-2011, 09:51 PM
I have no fucking idea what the OP means either, Magdalen.

What I will say is: I have a living will, and have done since I was in my late teens. Next of kin or anyone else's opinion doesn't come into it.

It would in the US.

scarletpeaches
03-08-2011, 09:52 PM
Not with a living will it wouldn't. If the patient's wishes are in black and white, signed and witnessed...mind you, you have that weird healthcare system going on where poor people are left to die in the streets.

Ya damn weirdos.

GeorgeK
03-08-2011, 09:53 PM
There are too many variables there to make a determination. Your feelings, the medical, proxy's, the presence or absence of DNR orders, if the incapacitation is to a minor, in which case the state can step in to protect the patient's rights...

True but there are only 10 slots in the poll section, which is probably a good thing or polls would be so long that nobody would bother.

kayleamay
03-08-2011, 09:54 PM
ETA: In response to SP.

But in the US, a family member can come in at the last minute, say they want you to live and that is what the docs have to do. Sucks, doesn't it?

scarletpeaches
03-08-2011, 09:58 PM
ETA: In response to SP.

But in the US, a family member can come in at the last minute, say they want you to live and that is what the docs have to do. Sucks, doesn't it?No, because those are the wishes I set out in my living will.

I can understand someone saying "Keep the machine switched on," even if you've said "No, switch it off," because where there's life, there's hope, after all.

What I would have a problem with is someone saying, "Meh, switch it off," when I'd said "NOES! I ARE STILL IN HYUH!"

GeorgeK
03-08-2011, 09:59 PM
Not with a living will it wouldn't. If the patient's wishes are in black and white, signed and witnessed...mind you, you have that weird healthcare system going on where poor people are left to die in the streets.

Ya damn weirdos.

Actually it does. When estranged family show up and the patient is unable to speak for themselves, often the living will becomes meaningless, especially if the person who brought the patient to the hospital is not a spouse. Most of the living wills aren't satisfactorily worded. It's the living who sue, not the dead.

Cyia
03-08-2011, 09:59 PM
Not with a living will it wouldn't. If the patient's wishes are in black and white, signed and witnessed...mind you, you have that weird healthcare system going on where poor people are left to die in the streets.

Ya damn weirdos.

Even with a DNR and executed living will, the hospitals have asked for next of kin consent in every end-of-life case I've been witness to - that's at least three in the last ten years.

They also require a separate DNR for "death in transit", meaning if they're transferring someone from hospital A to hospice or hospital B and they flatline in the ambulance, and there's not DIT DNR (the letters give me headaches!), they will attempt to resuscitate.

2 different hospitals, and one hospice.

Go back another five or so years, and there was a horrible mess with my great-grandmother, to the other extreme. Her care facility decided that "living will" meant no medications, even basic antibiotics.

They're a mess over here.

I'm fairly certain the only facility that honored the person's living will verbatim was the VA hospital with my uncle.

Sarah Madara
03-08-2011, 10:00 PM
I think he's asking if your next of kin doesn't know what you want, then what are the odds their own moral code will have them follow your wishes.


No, he's asking what the tipping point should be. Doctors can't predict whether you'll recover or not, but they have statistics on outcomes for other patients in similar circumstances. What would those statistics have to be for your family to pull the plug?

I don't have an answer. I don't have a living will yet, and I haven't broken this down to numbers. I think my husband and I have similar ideas about quality vs. quantity of life, and I would trust him. Although I'd say if I'll be too dependent to be able to successfully kill myself, then let me die. Otherwise, if I disagree with the decision, I can always correct it...

Devil Ledbetter
03-08-2011, 10:02 PM
Define "normal function." For that matter, define "disability." There is a world of difference between a 25% physical impairment and a 25% mental impairment.

kayleamay
03-08-2011, 10:03 PM
Would a living will be as easily ignored if it was tattoed on the patients chest? Just curious. (And maybe planning.)

scarletpeaches
03-08-2011, 10:05 PM
What if their chest was crushed in a freak baboon attack?

Devil Ledbetter
03-08-2011, 10:07 PM
Would a living will be as easily ignored if it was tattoed on the patients chest? Just curious. (And maybe planning.)My brother-in-law is an ER nurse who says he's going to have DNR tattooed across his chest.

Celia Cyanide
03-08-2011, 10:07 PM
The abortion thread and the end of life thread got me thinking. In a scenario where you are the patient and your own opinion is not allowed to be known by the the person making your medical decisions, so it has to be a proxy consent situation, what are the odds that that person should use to make their opinion on whether to pull the plug or abort you?

Sorry, to abort you? You mean, if you are the fetus? I'll refrain from answering until this is clarified.

kayleamay
03-08-2011, 10:08 PM
My brother-in-law is an ER nurse who says he's going to have DNR tattooed across his chest.

Yeah, I'm an ER nurse too. When you see enough of these scenarios, you get pretty set on what you do and do not want.

Williebee
03-08-2011, 10:10 PM
A stranger is making the decisions for you. What do you hope that they will decide for you?

Well, first, I hope they check my phone, wallet or Google and contact my family.

Barring that? If I am unable to communicate my wishes, and am still unable come -- say, the next billing cycle, dope me beyond a reasonable doubt of awareness and pull the plug. (I have no fear of death, but I'm a wimp when it comes to pain.)

My wife and I's DNRs are on file at all the area hospitals. Past experience has shown that that isn't always enough here in the states, sad to say.

Williebee
03-08-2011, 10:12 PM
What if their chest was crushed in a freak baboon attack?

Are there not ANY normal baboons around SP? Do they ALL have to be freaks?
:)

scarletpeaches
03-08-2011, 10:15 PM
Sorry. What can I say? I'm a 'boon-magnet.

regdog
03-08-2011, 10:17 PM
ETA: In response to SP.

But in the US, a family member can come in at the last minute, say they want you to live and that is what the docs have to do. Sucks, doesn't it?

So my signed and notarized health care proxy that my lawyer has is invalid if my mother shows up at the hospital?

kayleamay
03-08-2011, 10:17 PM
So my signed and notarized health care proxy that my lawyer has is invalid if my mother shows up at the hospital?

Yep.

ETA: It might be possible after some time (if your lawyer is willing to go to bat for your unconscious self) to have your living will executed, but most likely, the hospital will concede to the living family member, because as GeorgeK stated, the living sue, not the dead.)

Williebee
03-08-2011, 10:19 PM
ETA: In response to SP.

But in the US, a family member can come in at the last minute, say they want you to live and that is what the docs have to do. Sucks, doesn't it?

I'm not sure this is true, state to state. But it wouldn't surprise me. Do you have a source for this, for more information, please?

scarletpeaches
03-08-2011, 10:20 PM
I find that very hard to believe.

If it were the case, there would be no point in having a living will.

FWIW, I'm in the UK with no next of kin. Maybe my mother's still alive, I don't know. But my friends all know my wishes; I've been independent of my parents for over 13 years and I've even spoken to my GP about certain healthcare situations/emergencies.

TerzaRima
03-08-2011, 10:22 PM
Define "normal function." For that matter, define "disability." There is a world of difference between a 25% physical impairment and a 25% mental impairment

Yep.

Our culture is queasy about the sick and diminished, and is queasy about dependency even though it can be quite powerful in its way.

kayleamay
03-08-2011, 10:24 PM
I'm not sure this is true, state to state. But it wouldn't surprise me. Do you have a source for this, for more information, please?

I'm looking for sources. I don't know if it varies from state to state.

Cyia
03-08-2011, 10:25 PM
Most hospitals where I've had relatives as patients view a living will as a courtesy to the patient's relatives informing them of their wishes - nothing more.

In the case of the Death in Transit DNR, I was around eighteen when a woman was going door-to-door with the attending doctor, desperately looking for 2 people who could witness the document for her mother. Even with the doctors having the woman tell them herself that she didn't want to be resuscitated, and even with her children agreeing, they refused to agree to a DNR situation without the form, lest they be held accountable if she died in the transport ambulance and one of her kids hold the hospital liable.

It's all a round of CYOA

Xelebes
03-08-2011, 10:26 PM
Cognition, Experience and Prospects. Those are my three criteria.

What are the capacities of my cognition?
What is the experience I am going through?
What prospect do I have for recovery?

Percentages are not a measure.

kayleamay
03-08-2011, 10:34 PM
So far, this (http://www.hospicepatients.org/hospic26.html) is the only site I can find that refers to it (third para from the bottom...and it's for hospice so it's expected death). Most of the sites I'm coming across are pushing for Durable Powers of Attorney.

This (http://allnurses.com/general-nursing-discussion/dnr-questions-family-336805.html) site is a bunch of nurses discussing this very topic.

Cyia
03-08-2011, 10:34 PM
FWIW - Google Mae Magouirk, who was an octogenarian from Georgia, whose wishes were to be KEPT on life support until such time as she was terminal or PVS, her next-of-kin tried to honor those wishes, but the court assigned custody to her granddaughter, who instructed the hospital to withhold food and water because she felt it was time for her grandmother to "go home."

http://www.hospicepatients.org/mae-magouirk-04-08-05-press-rel.html

It has been reported that Mae Magouirk has a living will specifying that she does want treatment, is not ready to have her life ended (she wishes to live), and would not wish to be dehydrated within a hospice! It is striking that the court has chosen to ignore the express wishes of Mae Magouirk in her living will, and appointed as guardian, a granddaughter determined to assure the death of Mae Magouirk.

And the resolution of the case, if it is to come in time to save Mae, will come through the courts since the granddaughter has been awarded guardianship by the courts, which trumps any power of attorney for health care that other family members have had all along!

She had a brother, and other relatives, who were fighting the decisions of the court when the granddaughter was appointed guardian. They successfully removed her from hospice 1 month before she died, after making a short-term recovery.

regdog
03-08-2011, 10:35 PM
Yep.

ETA: It might be possible after some time (if your lawyer is willing to go to bat for your unconscious self) to have your living will executed, but most likely, the hospital will concede to the living family member, because as GeorgeK stated, the living sue, not the dead.)

My Aunt is the person named on my health care proxy, I hope that suffices.

GeorgeK
03-08-2011, 10:37 PM
Sorry, to abort you? You mean, if you are the fetus? I'll refrain from answering until this is clarified.
Yes, or if you prefer, assume an adult with a head injury or anything else. I'm trying to understand if in a general way, peoples' attitudes in a very general way are a normal distribution or if there is some sort of multimodality, statistically speaking.

regdog
03-08-2011, 10:37 PM
So far, this (http://www.hospicepatients.org/hospic26.html) is the only site I can find that refers to it (third para from the bottom...and it's for hospice so it's expected death). Most of the sites I'm coming across are pushing for Durable Powers of Attorney.

This (http://allnurses.com/general-nursing-discussion/dnr-questions-family-336805.html) site is a bunch of nurses discussing this very topic.

I will be getting a Durable Medical Power of Attorney.

Cyia
03-08-2011, 10:39 PM
I will be getting a Durable Medical Power of Attorney.

Keep it updated. They expire.

Williebee
03-08-2011, 10:46 PM
So far, this (http://www.hospicepatients.org/hospic26.html) is the only site I can find that refers to it (third para from the bottom...and it's for hospice so it's expected death). Most of the sites I'm coming across are pushing for Durable Powers of Attorney.

This (http://allnurses.com/general-nursing-discussion/dnr-questions-family-336805.html) site is a bunch of nurses discussing this very topic.

Your link does show this:
"It should be realized that even one vocal family member can turn the dying process "upside down" and violate the patient's wishes if there is no DNR form filled out."

Darling Bride and I did Durable POA's the last time we updated our wills.

TerzaRima
03-08-2011, 10:51 PM
What are the capacities of my cognition?


This is a good question. Cognition is not a monolithic construct--you might have a severely disabled short term memory and, say, intact visual-motor skills.

I provide counseling and information for women pregnant with a spina bifida-affected fetus. Families always want a prediction somewhat similar to the poll, but disability is not a binary idea. You can have a disability in one domain and not in others.

kayleamay
03-08-2011, 10:55 PM
Your link does show this:
"It should be realized that even one vocal family member can turn the dying process "upside down" and violate the patient's wishes if there is no DNR form filled out."

Darling Bride and I did Durable POA's the last time we updated our wills.

I know, and that link is also for a hospice site and in hospice care, dying is expected. It was all I could find. Everyone is hospice has a DNR form. However, I have received more than one patient from hospice care when family members panicked near the end and overturned it. The hospice workers usually try to talk them out of this, but if the family member doesn't relent, they get sent the ER and we do the full CPR/ACLS/Intubation torture routine.

LOG
03-09-2011, 12:37 AM
Can you set up a will that'll sue the hospital for trying to keep you alive?

Cyia
03-09-2011, 12:39 AM
If you're in a state where your living will would be needed, then you're not in a state to make decisions like that - but your relatives would be. Now, if someone actually defied the odds and recovered from a catastrophic injury, they might be able to throw a fit based on the hospital's not following their wishes, but they might also just be happy to have a pulse.

citymouse
03-09-2011, 12:40 AM
I was in the end of life situation in 1991. My father had a very explicit LW that was drawn by his lawyer. I was asked to read it and witness it, as I was also the executor. The main instruction was that no extraordinary means of life support systems be used to prolong a body that is terminally ill. However, as my father lay dying the medicine men came to me asking to perform an operation. It was explained to me that after the operation my father would be on life support. The success of the operation itself was less than 10%. I couldn't believe my ears! These guys knew the LW was intended to relieve me of the burden of making this decision and yet I was asked to forego my instructions. Unless you've been there with your mother, and family waiting for an an answer, you can't imagine the torment.

It's also easy to say in the full flush of health that we would spit in death's face. I felt most of the 'let me die with dignity" expressed in some posts here, then last year I fell ill with cancer. Angel wings fanning your bed brings a different perspective.

One should part from life as Odysseus parted from Nausicaa—blessing it rather than loving it. ~Friedrich Nietzsche

billythrilly7th
03-09-2011, 01:06 AM
We already have health care proxy forms for this scenario, and my Aunt and I have discussed it at length. We both have stated that in the even one of us suffers illness or brain damage to the point of incapacitation, ie. unable to feed ourselves, care for ourselves, irreversible coma, we want the plug pulled.

Yank it like you're starting a mower.

Monkey
03-09-2011, 01:07 AM
I would want my husband to make the call.

He would be the one who had to live with me, feed me, carry me around. He'd have to deal with whatever physical or mental issues I had, and pay my medical costs. His responsibility, and therefore, his call.

If he decided the responsibility was too much for him to bear, I would NOT want him to sign the papers to keep me alive and then divorce me. That would be unbearable on so many levels...I would really, truly rather be dead.

TerzaRima
03-09-2011, 02:21 AM
Can you set up a will that'll sue the hospital for trying to keep you alive?


Wow, maybe. Talk to your attorney and see if there can be a codicil wherein zombie Ed McMahon eats the medical team if any of them give you an owie.

shawkins
03-09-2011, 04:54 AM
Yikes. This is a grim and interesting thread.

Could anybody recommend a book/link/whatever that has sane and reasonable advice about planning for this sort of thing?

Regarding the OP: I sort of doubt that my position is legally enforceable, but since you asked: I'd prefer to die rather than survive a problem that left me unable to care for myself. I'd draw the line at 50/50 odds of requiring permanent care. At 51% chance of an unfavorable outcome I'd prefer that the plug be pulled, if that were feasible.

I like to think that opinion wouldn't change, but I guess there's no way to know for sure until you're actually dealing with the situation. And, again, yikes.

AncientEagle
03-09-2011, 05:30 AM
Before you declare that you'd rather die than be a burden to someone else, think carefully, and consider how that someone else may feel about it. My wife, who was extremely active, constantly on the go, self-sufficient, was hit by metastatic melanoma that broke her spine and paralyzed her from the chest down. I've been her caregiver for the past 14 years. (No, I'm not a saint, I don't need congratulations; I am the one who benefits from her presence in my life.) Her life was turned totally upside down, as was mine, and we have both gone through extended episodes of terror when the cancer has returned and threatened her life all over again. Yet we have had a great additional 14 years, despite all that. She didn't want to be a burden to me, but I wanted that burden, when faced with the alternative. Consider that before you check out voluntarily.

An aside: One day we learned that an acquaintance, a female quadriplegic, had been divorced by her husband. My wife pointed out to me that this was the third paralyzed acquaintance of her's whose husband had divorced her. She said, "Why didn't you walk out on me?"

I said, "Honey, I really wanted to, but every one of the women I asked to go with me refused." Even though paralyzed, she can use her arms, but she didn't bother to hurl the TV remote at me.

We can still laugh. That's worth a lot.

citymouse
03-09-2011, 06:46 AM
So far, this (http://www.hospicepatients.org/hospic26.html) is the only site I can find that refers to it (third para from the bottom...and it's for hospice so it's expected death). Most of the sites I'm coming across are pushing for Durable Powers of Attorney.

This (http://allnurses.com/general-nursing-discussion/dnr-questions-family-336805.html) site is a bunch of nurses discussing this very topic.

A word or two on Durable Power of Attorney docs. This document is of extreme value in ensuring and protecting people. However, a DPA is also a nuclear document. In it the signatory empowers another person the right and privilege of deciding issues or finance, well being, care, and end of life care; just to name a few. Those who are married have protections in law. However, people who are not married but have relationships complicated with property or children in common, are at risk if they opt for a DPA. It is recommended that more than one person be a party to a DPA to guard against abuse of the authority this document grants. I have granted a DPA with my sister as a co-administrator. She has my Living Will as well as instructions on how I'm to receive care if I cannot speak for myself. Both she and my appointed administrator must agree in every aspect of my intentions before anything is done on my behalf. This may seem cynical on my part, but I've seen too many abuse cases to trust in anyone with my life decisions alone.

Monkey
03-09-2011, 07:33 AM
Before you declare that you'd rather die than be a burden to someone else, think carefully, and consider how that someone else may feel about it.

That's exactly why I want my husband to make the call. What level of function makes whatever difficulties he goes through "worth it"? I can't make that call--only he can, and only if he's ever faced with the actual situation.

I would hope that he wouldn't bankrupt the family keeping me alive but in a vegetative state...but even at that...his call.

Celia Cyanide
03-10-2011, 11:41 PM
Yes, or if you prefer, assume an adult with a head injury or anything else. I'm trying to understand if in a general way, peoples' attitudes in a very general way are a normal distribution or if there is some sort of multimodality, statistically speaking.

I guess it is hard for me to think about this in terms of, "what if you were the fetus?" because the decision isn't ever really about what the fetus wants. It is always about what the woman carrying the fetus (and her family) thinks is best. I've often heard the question, "what about the baby's choice?" when the baby never gets a choice. I didn't choose to be born. My mother chose to have me.