Wednesday, January 2, 2008

Ethics of Dying: Medical Power of Attorney

I made end of life decisions for both my grandmothers and my mother. My paternal grandmother died from stomach cancer back in the seventies. She did not have any of the legal documents available today. Everything was done on the basis of her wishes in a tacit agreement with her doctor and the hospital. There were no extraordinary measures taken, but everything was done to keep her comfortable. My mother and I were able to keep her at home until the last few weeks. My mother changed to a night shift (I worked days), so my grandmother was alone each day for only a couple of hours. While my grandmother was weak, her mind was clear until the end. The last days were difficult as she needed more and more pain medication. She turned the decision-making over to me, so I opted for her comfort even if it shortened her life by a few days. My mother and I were both with her when she died.

When my maternal grandmother came to live with us many years later, I knew she needed legal documents if I was to make decisions for her. She met with an attorney and had the necessary documents executed. I was designated as her agent in her medical power of attorney. Over the next seven years she lived with us, I would use that medical power of attorney several times including her final illness. In Texas, a medical power of attorney is only effective if the person who executed it is unable to make their own decisions. My grandmother ws competent, if stubborn, most of the time. However, she had several procedures that involved sedation or mild anesthesia. At those times, I took over the decision-making.

At age 96, she had major surgery from which she never recovered. After the surgery, she never really regained consciousness, so I made her choices as to treatment. I acted under the medical power of attorney. All seven of her children were able to visit her before she died. One aunt strongly objected to some of my decisions, but all she did was tell me of her disagreement. She could have done much more. Any legal document can be challenged including living wills and medical powers of attorney. While the courts usually follow the wishes of the person who executed the documents, court disputes can delay end of life decisions. The best way to avoid courtroom showdowns is to make sure your end of life decisions are known to all your immediate family and that these choices are clearly spelled out in the proper documents.

My mother had Parkinson's disease (PD), and after sixteen years PD killed her. I made the decision to keep her comfortable, but nothing more. I am an only child, so there was no one to object. Nevertheless, it was easier to act because I had her medical power of attorney. Friends and family stayed with her in the morning; I stayed every night. I held her while died early one morning. Even as my brain knew I had made the correct decision, my heart told me I had let her go too soon. Only knowing that she did not want machines provided solace.

I believe everyone should execute a medical power of attorney if there is someone that you would trust with your life. I think it is wrong to execute a medical power of attorney unless thought has been given to who will make decisions. Do not wait until you are in the hospital facing life and death decisions. You also need to consider what actions you want your agent to take in different situations and tell whoever holds the medical power of attorney your exact wishes. Do you want artifical nutrition, artificial hydration, a respirator, heroic mesasures to keep your hear going even though some procedures might break ribs? Talk to someone who has used a medical power of attorney. Find out what they faced. Above all, discuss these issues with those around you.

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