Dear Judy,
My friend was a dynamic 86-year-old who had all the tools in place for a peaceful end. He had a health care proxy, a Living Will and a loving family who supported his wish for just palliative care. In other words: he wanted no life-prolonging measures after cancer invaded his bones.
He was so adament about this choice that when he slipped in a shower one day and broke a hip, he absolutely refused a doctor’s suggestion he get a hip replacement. Instead he went to a hospice. He wanted pain relief, but insisted that was it. He wanted no food or hydration. He just wanted to drift away.
This plan (agreed to by the hospice doctors) was foiled repeatedly by intrusive nurses and other staff members. In fact they persisted in bring him food trays, and encouraged him in his sedated state to eat!
His family, realizing that the only way his last wishes could be honored was to stay with him day and night, had to position one member by his bedside at all times to protect him from these caretakers.
Judy, this scenario is not unique and I’m wondering why you haven’t explored the problem. Hospitals and medical personnel frequently ignore health care proxies and Living Wills, refusing to honor a dying patient’s explicit instructions. Why don’t you write about this?
Anne in LA
Dear Anne,
Since I’m a hospice volunteer, I am truly astonished that medical personnel at your friend’s hospice ignored his last wishes and tried to tempt him with food. In my experience that’s unheard-of behavior in hospices, which are devoted to palliative care.
I know what you mean about hospitals though. There is absolutely no guarantee, thus far anyway, that medical personnel or hospitals will abide by a dying person’s Advance Medical Directive — even though the Federal Patient Self-Determination Act of 1991 did mandate patient decision-making.
Worse, there are no legal consequences if medical personnel override those last wishes. I think these days about the best thing anyone with a serious illness who’s going to a hospital can do is to take a copy of that Advance Medical Directive along. And make sure a vigilant relative or friend safeguards the document.
I realize this isn’t a perfect solution. But it’s the best I can come up with right now. If anyone has a better idea of how to ensure end-of-life decisions are respected, I welcome their emails on the subject.
Thank you for writing,
Judy
