Advance Decision

[Lowerfield_no_more]

I posted this elsewhere within the community in another thread, and thought it worthwhile reproducing it as a stand-alone topic. For those who have heard of the 'Living Will' the 'Advance Decision' is the more recent equivalent. It must be made whilst you are of sound mind.

'I have an 'Advance Decision' which I very carefully put together nearly ten years ago. It defines the conditions where I do not want medical intervention should I become very seriously incapacitated. I discussed this with my family and my GP at the time, and it is independently witnessed and a copy is with my GP. I consider the 'Do Not Resuscitate' is too easy to misinterpret. I urge everyone who may be faced with this situation to consider getting an Advance Decision prepared, as I did. It's your life that you may wish to sustain, or conversely allow to slip away if the circumstances dictate, and sometimes the medical profession have a conflict of interest in dealing with some end of life situations, as I found out when my elderly mother, who had several serious health conditions including Alzheimers, was 'saved' after what was possibly a major stroke which caused her to lose consciousness, by a well meaning doctor who though she was doing the right thing when in fact she wasn't, a point of view which I very robustly put forward to those responsible, although in the end my mother never recovered consciousness after several weeks and was allowed to slip away.

For those who want to know more about the Advance Decision there are several UK based health organisations who have webpages devoted to this e..g Age UK, and some with pro formas to use and modify as you feel appropriate.

[Taviterry]

Good tip, and I'll look into Advance Decisions, When Mum was taken to hospital with pneumonia and delirium, the doctor warned me and her sister that this might be the end and would we want resuscitation. My aunt immediately said "no", and I agreed. In fact Mum recovered and had another 15 months or so in a nursing home; she seemed content enough when I visited, though she virtually bed-bound.

During Lockdown I made Enduring Powers of Attorney (financial and health) and made it clear that I did not want resuscitation. I made that point to my surgeon before my TAVI, and I was a bit miffed when I saw my discharge letter that said that I had opted for it. My cousin suggested that medical staff might feel obliged to do all that they could for a patient, rather than face a claim for negligence from a relative.

[mozart27 in reply to Taviterry]

Please be careful with terminology. It has not been possible to create Enduring powers of attorney, which have any validity, for a long time now and EPAs only ever related to financial matters. They were replaced by Lasting powers of attorney and LPAs are of two kinds, one covering financial matters and the other covering health and welfare matters. Also be aware that an Advance decision, which is something different, may not in practice be acted upon by ambulance crews attending an emergency or in hospitals. I have, in addition to my Advance decision made a Respect form with my GP which contains my wishes about resuscitation. Given both my Advance decision and the Respect form , I hope my wishes will be respected.

[Taviterry in reply to mozart27]

My mistake. Recently my cognitive powers have declined, to the extent that I'm having minor problems deciding between two options, such as which bin to put household waste in!.

[mozart27 in reply to Taviterry]

It has been really confusing with all the changes made over the years

[Poppeye]

This is a very important topic as well as being a grey area both ethically and legally. My wife has a "Treatment escalation plan (TEP) and resuscitation decision record" which is an NHS document and has been prepared by her GP. I presume this forms part of her medical records and would be flagged up in any emergency that the NHS were involved with.

But it only seems to cover her decision not to receive CPR.

Many years ago, my mother-in-law was found unconscious at home near the end of her life. Her GP said "we could just let nature take its course and let her slip away...or she could go to hospital where they will administer "clot-busting" drugs which might restore her consciousness".

On the advice of the GP the latter course of action was taken, she regained consciousness but the extra two months that she gained was of poor quality.

I am due to have a similar document to my wife's prepared for myself but, in addition to refusing CPR, I would like to be able to refuse clot-busting drugs in the event that I am found unconscious following a brain injury.

It is difficult to spell out precisely the circumstances under which I would like no "life-saving" medical intervention but I feel that it is important to give it some serious consideration. I have recently had a "near-death" experience and it wasn't bad at all. I am not frightened of it and I would set the bar pretty low when it comes to refusing intervention.

[fishonabike]

thank you for that, I will certainly be looking into that

[Thanksnhs]

Thank you for posting that, I have recently made a new will and POA I said to my lawyer about a DNR which is what I want and she said that there was no provision to put it in either document and that I would have to have something else to say that's what I want. Char

[WPTC in reply to Thanksnhs]

Thank you for discussing these things. Me and my relatives were suddenly unexpectedly faced with a horrendous decision whether to try to treat or allow nature to take it's course for our lovely mum. We don't know what decision she would have wanted. Not knowing much about advanced plans at the time she didn't have any and we had never discussed as she was fit and well up to two days before she passed away.

The medics said she could be put on a ventilator but would probably not recover due to embolism after hip replacement for fracture after a fall. Her chances of recovering were given as less than 1 in 100.

I had just worked a night shift and was too exhausted and shocked to make a sudden quick decision for mum. Knowing mum's fear of hospital and nursing homes we thought she would have wanted to be allowed to slip away but always I have felt tortured by what if she just might have miraculously pulled through and years later i still feel really sad and upset in case we did the wrong thing for her.

I don't know what is best/right in this difficult area. Sorry for long post.

[Taviterry]

I've looked at the RESPECT and Advance Decision forms and read the background info, and have emailed my surgery about completing them, warning that "I have a brutally pragmatic view about future care and my death. Seven years ago, in happier days, a retired GP looked shocked when I said, only slightly flippantly, that if I had a chance of death I would go for it! " (This was in preference to my enduring poor quality of life towards its end.