LPA Health and Welfare - what to advise my attorneys?

DH hadn't (and hasn't) got Alzheimer's but even so, that is no reason to DNR without permission.

RedRidingHood

I've an idea that LPA and Advanced decision are incompatible. One overrides the other though I can't remember which.

You are mistaken. They are not incompatible, I have both.

I have also , held POA for someone with an AD. She was terminally ill, had had enough, and decided that when the next crisis arose she was ready to let go of life. I was there in the hospital when she activated her AD and stayed with her to the end. She just slipped away and died very calmly and peacefully a few hours later. As she wished.

Obviously, you appoint LPA to someone who knows about your AD and is willing to support your intention. Do not pick someone whose religious beliefs might be incompatible with refusing treatment.

(I have 2 named LPA's . One is a backup in case the first was incapacitated. )

My mother has a DNR in her medical notes. I hold her LPA and once it was deemed she did not have capacity, I was asked if I would make the decision. As Mum's quality of life is so poor with her dementia, as a family we made the decision and I reported that decision back to the Care Home as LPA.

I am not an expert but wonder if there is a confusion here bteween LPA and a living will. The latter has no legal force but gives your family and doctors guidance at end of life.

Consult with you GP to have an official SNR on your meducal recirds. Any admission to a care setting, hospital should be aware of this. As for collapsing in the street not able to communicate, different situation. Most people would look for a resuscitation machine or try to apply CPR. Your LPoA should contain your wishes. Give out copies to those concerned.

I think this is one of the most difficult aspects of an LPA, because it is very nuanced. And it changes over time. What seems unthinkable at 71 might seem quite different at 91 (if I get that far.....) My mum (91) decided not to write anything in her LPA - I'll work with my brother to try to make the best decisions we can for her, if this becomes necessary.

There is a great book by Atul Gwanda called 'Being Mortal' about what constitutes quality of life and how to decide on appropriate interventions towards the end of life. There are difficult decisions in emergency situations, but also for example in cancer care, where prolonging life v quality of life can become a difficult balance.

I think that the best we can do is to try to work out what QoL means to us each on a personal level, and at what point we would become too miserable to want to continue. We need to keep this under review for ourselves at least. Much harder to do for others.

@butterandjam thank you, I wasn't sure.
I'm just dithering over the wording on my LPA.
We did financial ones years ago. DH and both DC are named.
I really don't want to live with huge reduction in quality of life. I imagine it's hard for loved ones to let you "give up" too soon.
What wording have others used?

My late DH had a DNA, known as a yellow envelope.He had severe heart disease for many years, had bypass surgery but it started to break down.He told me he did not want to have I again and to just let him die.He hated the big impact the disease had on his life and the way it restricted his activities.
His heart was working on less than half it's power in the 12 months before his death.
What I hared was the way it was put t us in the hospital.A doctor came to talk to us in the ward at visiting time.I told her that this should be a private discussion not a conversation in a ward full of eavesdropping visitors and other patients.He too her he wanted no more treatment and be able to die peacefully
The doctor took me into an office then and gave me the form, inside a ''yellow envelope''. I was Tod to leave it in the house in a prominent position incase he collapsed at home and the paramedics would attempt resuscitation.He had to carry it on his person if going outside the house for the same reason.
It seemed like a death sentence but it was his wishes.

My mother told nursing staff that she wanted DNR put on her notes as soon as she got to hospital - I was surprised but willing to go with her wishes. She'd seen quite a few friends survive unhappily for weeks in hospital with no real chance of recovery. They all eventually died.
She had recurring bouts of serious chest infections and they kept giving her more rounds of the same antibiotics which were making no difference, just keeping her alive in very poor health.
Eventually we were called in the night to say that she was very sick and that we should go to see her, only to find that they were about to give her yet another useless identical round of antibiotics. When we questioned this we were told that they wanted us to instruct them to discontinue the treatment, we were happy to do this as we knew that was exactly what she would have wanted. She died quietly at breakfast time the next day.

I wish I had known about DNRs for my mother. She had Parkinson’s for 25years. She was taken into hospital unconscious with a kidney infection. The young doctor said that they could put a feeding tube into her stomach which would keep her alive for another 5 years. Would she have done that to her mother or even a dog?
In her nursing home she was kept alive unnecessarily, the doctor was called for every little ailment. She was rigidly in a curled up position . Gradually over 4/years she lost her hearing ,sight and speech and eventually the ability to swallow.
She would have approved of the euthanasia bill, but unable to do anything to remove her suffering.
We were never asked if we would approve DNR for her but it made me certain they I would ask for one for myself.

Fartooold

NotSpaghetti I did hear of a lady who did have a tattoo on her chest DNR and on her back PTO!

Brilliant!

We have both added a paragraph to our Health and Welfare Ps of A to say roughly:

‘If I should develop dementia, or any other condition where I am unable both to care for myself, and speak, with full mental capacity, for myself, then I emphatically do not want any life saving or life prolonging treatment. I ask for palliative care only.’

Milest0ne

I wish I had known about DNRs for my mother. She had Parkinson’s for 25years. She was taken into hospital unconscious with a kidney infection. The young doctor said that they could put a feeding tube into her stomach which would keep her alive for another 5 years. Would she have done that to her mother or even a dog?
In her nursing home she was kept alive unnecessarily, the doctor was called for every little ailment. She was rigidly in a curled up position . Gradually over 4/years she lost her hearing ,sight and speech and eventually the ability to swallow.
She would have approved of the euthanasia bill, but unable to do anything to remove her suffering.
We were never asked if we would approve DNR for her but it made me certain they I would ask for one for myself.

Did you not think of speaking to the staff? When my mother was already over 90 with advanced dementia, I spoke to the staff who agreed absolutely that trying to prolong her life would be verging on cruelty. So we agreed that there would be no hospital unless absolutely necessary (e.g. for a 2nd broken hip) and no ‘striving to keep alive’.

Applegran

I am not an expert but wonder if there is a confusion here bteween LPA and a living will. The latter has no legal force but gives your family and doctors guidance at end of life.

NHS share.google/rBXlrZZog8CPe84aY

Correctly used and applied, a valid Advance Decision is legally binding.

Think you can talk over and write up your wishes for your medical records and with your next of kin.

But please be careful. I was present at an accident where a young woman was hit by a car. Apart from the crash injuries, her heart stopped in loss of blood shock about three times before the ambulance got to us.
She does have life changing injuries to her legs, but is recovering. I was told that shock is one of the major causes of heart stopping.
What you may need is something like a wish that no heroic action taken perhaps? My mother had "palliative care only"

An LPA is quite different - there are two types, both handing over decision making to those nominated - one medical and one financial.

When I redid my will I took out both powers of attorney. My daughter and son in law are my attorneys they both know what my wishes are as I believe in quality of life not quantity. I trust my son in law as much as I trust my daughter so I know they will follow my wishes.

My husband knew what my wishes where everytime I had an operation and when my health got worse. I knew his wishes when he was terminal and he died at home as he and we wanted just with us. I even told him to stop struggling as even on full oxygen he couldn't breath. And said we will be ok . He died within minutes .

It's very important to take out both powers of attorney and tell your family your wishes . If you have no close family make sure it's on your GP and hospital records and your solicitor knows .

Thank you Butterandjam - I am indeed no expert and am grateful for your correction.

IMO the issue with DNR is, that it only applies to resuscitation if your heart has stopped. Doesn’t it?

So it has no bearing on ‘striving to keep alive’, with medication, drips, feeding tubes, etc.

That’s why we’ve added to our H&W Ps of A, as I’ve said above.