# Medical wishes of parents



## james4beach (Nov 15, 2012)

I'm in my 30s, and my two parents are quite a bit older. They're in good health, but (statistically speaking) are in a higher risk category for COVID19. Obviously I am hoping that none of us catch this, and that nobody ends up in the hospital.

One parent is quite opposed to the idea of calling for emergency services (if sick) and generally wants to try recovering on their own, at home. This parent is very opposed to certain medical interventions, and does not want intubation or the ventilator, if it ever comes to that. They don't want to set foot in a hospital.

I feel this puts me in a difficult position as the son. I am very likely to be the person who responds for help. Let's say I find this parent very sick with a flu-like illness and having trouble breathing... normally I would get them to a doctor, call the COVID hotline etc. But I'm hearing this parent request (verbally) that I don't.

I am not certain I should take that request seriously. Are they just scared because of hospital footage they're seeing on TV? *How serious is this wish?*

This parent does have healthcare instructions in a Living Will, which I haven't read, but somehow I doubt it covers such specific scenarios, such as whether or not to call for medical help for trouble breathing with flu/COVID.

What is the correct way for me to handle this? Keep in mind that they can't see a lawyer to update that Living Will. And I don't have their Living Will.

I want: (a) them to get reasonable medical help, (b) to respect their wishes, (c) to not get in legal trouble myself if someone later says I should have gotten them to the hospital, (d) don't want them to die at home on my watch, and then ask myself for the rest of my life if I should have called 911 even though the parent said they don't want to go to a hospital.


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## cainvest (May 1, 2013)

Get the lawyer to send you a copy of the living will, it may answer at least some of the questions and you can proceed from there.


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## james4beach (Nov 15, 2012)

cainvest said:


> Get the lawyer to send you a copy of the living will, it may answer at least some of the questions and you can proceed from there.


That sounds reasonable. I can also ask the parents to see the living will, I think they have an electronic copy. Until recently I considered it "none of my business".


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## cainvest (May 1, 2013)

Best to be informed, pandemic or otherwise.


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## MrMatt (Dec 21, 2011)

I agree, talk to the lawyer and your parents to be clear about their intentions, and have the lawyers support if it comes to that.

It's all well and good to say the "right" thing to do, but assuming someone is mentally competent, their wishes should matter more. If they don't want to be put on mechanical ventilation, that's their choice.


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## sags (May 15, 2010)

You should call 911 and your parents can refuse transport to the hospital if they wish.

If they are unable to refuse transport and end up at the hospital, and if they expressed not wanting to be on a ventilator, you should respect their choice.


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## james4beach (Nov 15, 2012)

sags said:


> You should call 911 and your parents can refuse transport to the hospital if they wish.


That's interesting, I had not considered that. Do ambulances respect a person's wish, if they say, don't take me to a hospital?



sags said:


> Once at the hospital, if they expressed not wanting to be on a ventilator, you should respect their choice.


You and MrMatt are right, that a person's wishes matter more than what I think is right.


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## sags (May 15, 2010)

People have to consent to medical treatment. People have the absolute right to refuse or stop treatment, providing they are mentally competent.

The paramedics aren't going to drag someone into the ambulance. They will try to convince the person to go with them. They can't force them to go.

If they are incapable of making the decision, you could have them transported to the hospital to receive treatment without a ventilator.

The doctors would make them comfortable and address the other symptoms. Some patients are already refusing ventilators.






Consenting or refusing health treatment - FREE Legal Information | Legal Line


Under the law in most provinces, an adult patient, who is mentally competent, normally has the sole right to refuse or consent to any health care treatment, even if refusal increases the seriousness of the illness or the possibility of death. Not every province’s mental health legislation, such...




www.legalline.ca


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## james4beach (Nov 15, 2012)

My parents are perfectly mentally competent. And the one parent who has strong feelings on this does not want to die... they just don't want a ventilator.


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## sags (May 15, 2010)

Then that is what they or you can instruct the doctors. All measures except ventilation.

But....ventilators are used during surgery. I was intubated during both of my surgeries.

So........make sure to specify the ventilator can be used during surgery if necessary. Otherwise they can't have the surgery.


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## MrMatt (Dec 21, 2011)

sags said:


> You should call 911 and your parents can refuse transport to the hospital if they wish.
> 
> If they are unable to refuse transport and end up at the hospital, and if they expressed not wanting to be on a ventilator, you should respect their choice.


No, if they don't want to go to the hospital, don't put a sick/dying person in the position of arguing with the ambulance.
Really, talk to the lawyer and get this sorted out before hand.

You might even want to talk to how to signal your wishes to the hospital if it comes to that.

Call the lawyer and talk over the phone, even if you can't see them in person, understanding the legal rights and obligations under the situation is important.

As far as being scared and refusing care, I remember reading about children refusing cancer treatment, and people saying that the child doesn't really understand and they're just scared. 
Then the oncologists interviewed talking about how they would refuse it as well, when an oncologist says they'd rather die than recieve certain treatments, and that refusing such a treatment is the choice they'd make.









Do Not Sign A DNR Before You Read This


DNRs are dangerous for patients with pneumonia, trauma, strokes, vascular problems and other treatable conditions, according to studies in the Archives of Internal Medicine and Critical Care Medicine.




www.investors.com




Get informed, talk to the lawyer.


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## newfoundlander61 (Feb 6, 2011)

"This parent does have healthcare instructions in a Living Will,". My wife and I have a POA for medical and it states in general terms that if mechancial intervention is needed to keep us alive then pull the plug. I would be surprised if your parents healthcare instructions does not have specific instructions in it as this is its purpose.


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## Plugging Along (Jan 3, 2011)

@


MrMatt said:


> No, if they don't want to go to the hospital, don't put a sick/dying person in the position of arguing with the ambulance.
> Really, talk to the lawyer and get this sorted out before hand.


I disagree with not calling for an ambulance. If someone is in serious medical distress that you believe requires emergency, you should call. This applies to not only family members but even strangers especially if they are elderly. 
I learned this when my mother fell while out with my dad. Instead of calling 911, she insisted she was just tired and just wanted to rest. She even managed to nag my father to go and finish the grocery run while she went to the room. My father came back and found that she didn't make it to the room and had collapsed. He called my sibling (he doesn't speak English well) who called 911. Even when paramedics arrived, my mother was still feisty and insisted she was fine. They took forever deciding what to do, and figure it wasn't a stroke, so took her to the hospital without the stroke ward after another 1.5 hours. She had a stroke and because everyone listened to her, she didn't get to the hospital in time to get the stroke treatment get the clot going, she then was in a hospital that didn't deal with strokes well so couldn't get the treatment for rehab which made her recovery worse.

There were many mistakes that were made that day, and speaking to friends in the medical field here's what I know now and won't make that mistake even again.

If some one looks like they need emergency medical attention and you are not a medical professional. Call 911.
Many people will do whatever they can to avoid an ambulance. One test, but not the end all, is if you ask them if you could drive them, if they say yes, then call ambulance. The mode of transportation should not matter.
Women are more likely to resist treatment. They will often downplay their symptoms because they don't want people to worry.
Men hide the need for help because they don't like appearing weak
If the person is elderly and they fall for ANY reason, call 911. This is a protocol at seniors homes.

I can tell you that my dad, sibling and I felt awful that it took so long to get into the hospital and then the wrong one. We also learned that the paramedics should have followed protocol and just taken her. We had that happen a second time with my mom when she fell again. My mom argued she was fine, didn't want to go, ect. The second time we took charge and she was brought in right away which saved her.

Get the person to the hospital and then worry about what kind of treatments the person would receive or not.


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## Plugging Along (Jan 3, 2011)

james4beach said:


> That's interesting, I had not considered that. Do ambulances respect a person's wish, if they say, don't take me to a hospital?
> 
> You and MrMatt are right, that a person's wishes matter more than what I think is right.


A paramedic will not force someone in the ambulance. They will either try to convince them to go if they think they need it or wait until the person becomes unconscious and can no longer offer consent. 

The persons wishes are more important than what we think. However, it is very important for the wishes to be clear. One can't say 'I don't say I don't want to go to the hospital' but then say 'I don't want to die'. The best thing you could do is talk to your parents to understand what their stances are. You can't go through every scenario but understanding their intention is important. You may not agree with it, but if you understand it, then you will be able to make decisions that are how they would.


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## Plugging Along (Jan 3, 2011)

newfoundlander61 said:


> "This parent does have healthcare instructions in a Living Will,". My wife and I have a POA for medical and it states in general terms that if mechancial intervention is needed to keep us alive then pull the plug. I would be surprised if your parents healthcare instructions does not have specific instructions in it as this is its purpose.


Even in your case you would want to ensure the POA understands the intent. My parents don't want to have to live if it requires a machine to keep them alive either. However, we were faced with decision that required my mom to be on multiple machines for breathing and pumping blood aka keeping alive if she undergone an extensive surgery for over 14 hours. There was also a chance she would need life support after.

Going just by their living will, technically we shouldn't through the surgery. My dad gave different directions which where go through the surgery but if she needs life support after that's when treatment should stop. Even my parents wishes which we understood had room for interpretation.

The most important thing is that you understand where they are coming from, and the best you can do is let them know your concerns and provide the facts. I am fortunate that my parents trust my judgement, and even more fortunate that as a family we have discussed these things. That being said, my parents have made decisions I have not agreed with in the past regarding their medical, and they were severely wrong. As much I as wanted to say "I told you so' and am stuck dealing with their poor decision in the past, I don't. I just keep helping them try and make the best decisions but have to accept that the decision is theirs.


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## Longtimeago (Aug 8, 2018)

Any reasonably competent adult is responsible for their own decisions and behaviour. 

If my son were to tell me he was worried about what to do because I was saying, 'I prefer to stay home', I would tell him it was not his decision to make, it is mine to make. Worrying about it is his prerogative but it has no bearing on MY decision. What I decide is how it will BE.

I find it insulting to think any child of mine would think they were more able to make a decision for me. Because I'm older doesn't mean I've become stupid. Every time I read a thread of this type, that is what these younger family members are implying whether they realize it or not. Adults take care of children, I haven't reverted to being a child because I got older.

Mind your own business as long as I am competent to make my own decisions. I've made them all my life and I've made them for you as well until you were old enough to start making your own.


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## Retired Peasant (Apr 22, 2013)

I hope someday you have a child James, that does this to you. Then, maybe you'll understand.


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## Money172375 (Jun 29, 2018)

Difficult decisions for sure. I can’t even imagine. I know my mother’s wishes, but not sure I could fulfill them.

not to compare the two scenarios, but.......our pet dog had a stroke last fall....she was 7 years old, conscious, but had difficult walking. Within an hour of the event, she was put down. I know the guilt of making such a quick decision still haunts my wife.....it bothered me for a few months....thinking that we should have given it a week or two to see if she got better or if we could cope.

saw an online post regarding these decisions whether it’s for pets or humans.....are You making the decision (either way) to make you feel better or the other person/pet better?

super tough and I’m nowhere near ready to make those decisions which would probably mean prolonging life (for better or worse). 

cuomo has said that only 20% of patients come off ventilators alive.....I never knew that.


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## Longtimeago (Aug 8, 2018)

Money172375 said:


> Difficult decisions for sure. I can’t even imagine. I know my mother’s wishes, but not sure I could fulfill them.
> 
> not to compare the two scenarios, but.......our pet dog had a stroke last fall....she was 7 years old, conscious, but had difficult walking. Within an hour of the event, she was put down. I know the guilt of making such a quick decision still haunts my wife.....it bothered me for a few months....thinking that we should have given it a week or two to see if she got better or if we could cope.
> 
> ...


I think most people could understand what you are saying Money172375 but you are still making the ASSUMPTION that it is your decision to make. With a pet it is, your mother is not a pet.

If you know your mother's wishes, there is no DECISION for YOU to make. She has made HER decision and informed you of what it is. Your responsibility is ONLY to abide by it. You don't have to like it, you don't have to agree with it but by g o d you must abide by it if you do not want to reduce her to the status of a child or a pet.


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## Longtimeago (Aug 8, 2018)

Retired Peasant said:


> I hope someday you have a child James, that does this to you. Then, maybe you'll understand.


I'm trying to imagine how I would fee Retired Peasant if my son phoned me and said, 'hey Dad, I'm thinking about if you get the virus, and what decisions I will make regarding your treatment.'

I'd probably break the distancing directive and go smack him for thinking he could make decisions for me. This kid I used to have to change diapers on is now trying to tell me what will happen with my life. Not a chance.


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## andrewf (Mar 1, 2010)

Longtimeago said:


> Any reasonably competent adult is responsible for their own decisions and behaviour.
> 
> If my son were to tell me he was worried about what to do because I was saying, 'I prefer to stay home', I would tell him it was not his decision to make, it is mine to make. Worrying about it is his prerogative but it has no bearing on MY decision. What I decide is how it will BE.
> 
> ...


Maybe you have never experienced this, but many older people suffer from cognitive decline, whether dementia or otherwise. My grandmother became quite child like in the last few years of her life. She had an animatronic pet 'cat' that she seemed to have confusion about whether it was real or not. She was wheelchair bound, and yet would ask if she could wash the dishes after a meal. She would insist that she could walk somewhere when she could barely take a few steps with assistance. She would become quite emotionally manipulative of my grandfather, as she was in full-time care while he was still in their assisted living apartment.

So it is not always very clear that your elderly family member has their faculties to be making these decisions rationally and pragmatically. Often it is hard to tell when it is carefully considered or knee jerk stubbornness or fear.


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## james4beach (Nov 15, 2012)

Retired Peasant said:


> I hope someday you have a child James, that does this to you. Then, maybe you'll understand.



Does *what* to me? There are a variety of opinions in this thread.


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## james4beach (Nov 15, 2012)

Plugging Along said:


> The persons wishes are more important than what we think. However, it is very important for the wishes to be clear. One can't say 'I don't say I don't want to go to the hospital' but then say 'I don't want to die'. The best thing you could do is talk to your parents to understand what their stances are. You can't go through every scenario but understanding their intention is important. You may not agree with it, but if you understand it, then you will be able to make decisions that are how they would.



Very good point. The person's wishes are the most important, but I've got to get clear on what exactly the wishes are.

As you say, once I understand the intention, I can make decisions that match what the parent wants.


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## Retired Peasant (Apr 22, 2013)

Not sure what you are saying Andrew; the discussion was around what to do when a POA for care has been done. It sounds like your grandmother did not have a POA, and of course cannot create one if incompetent. But James is referring to his parent, _who has a POA_ in place. He needs to follow that, if he has been named the POA. He doesn't even know if he has. 

My assumption would be that his other parent has been named (perhaps with him as a alternate (not the same as co-)).


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## sags (May 15, 2010)

Who is going to ask to see a POA ?

The hospital never asked me when I had to make the decisions for my parents. The decisions were done in the ICU units of two different hospitals.

I was presented a paper to sign and that was that.


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## Plugging Along (Jan 3, 2011)

sags said:


> Who is going to ask to see a POA ?
> 
> The hospital never asked me when I had to make the decisions for my parents. The decisions were done in the ICU units of two different hospitals.
> 
> I was presented a paper to sign and that was that.


If the person is incapacitated mentally or physically, they will go to the rules of next of kin if possible. When my mom had her stroke, the care and decisions were made by my dad, but he also told the hospital that my sibling and I can speak on his behalf (we do the translation). No paper work was required under the emergency situation. 

As she recovered (sort of) from her stroke, it was apparent that her mental capacity had further diminished. We had concerns regarding mental health over the years, but the process to 'prove' it and help her get treatment was next to impossible. The stroke and extra assessment available had proven that she no longer had the competence to make decisions. At that point, I had to official enact her POA and PD through our provincial processes. 

From that point on, any care decisions I had to ensure that a copy of the PD and the supporting paperwork was provided and in their files. I found when there were emergencies and I had to go the hospital, they didn't ask me for the paperwork, but did ask me if I have the PD for when I had to make major life decisions. It was always on file, but they always asked, just not at the moment they were treating her. I had to sign the discharge papers, and they confirmed that I did indeed have PD when we chose to change her level of care. 

I am very grateful that my parents had most of their stuff in order well before I needed it, and as a family we had spoken about many of these issues even though I didn't want to. I can say just having the paper work was one less stressor in an extremely stressful time.


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## Money172375 (Jun 29, 2018)

james4beach said:


> Very good point. The person's wishes are the most important, but I've got to get clear on what exactly the wishes are.
> 
> As you say, once I understand the intention, I can make decisions that match what the parent wants.


careful....I’ve learned in this thread, you can’t make decisions.....your parents already have made them for you.


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## Money172375 (Jun 29, 2018)

sags said:


> Who is going to ask to see a POA ?
> 
> The hospital never asked me when I had to make the decisions for my parents. The decisions were done in the ICU units of two different hospitals.
> 
> I was presented a paper to sign and that was that.


I’ve witnessed where the doctors and nurses kept asking....”do you want us to make her more comfortable (ie. ease the pain and increase the meds)? In hindsight it felt like euthanasia.


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## Longtimeago (Aug 8, 2018)

Money172375 said:


> careful....I’ve learned in this thread, you can’t make decisions.....your parents already have made them for you.


What is it some people don't understand about this. IF the parent is mentally competent to make their own decisions, YOU don't make decisions for THEM Money173375. They make their own decisions.

It is only if they are unconscious that you might have anything to say about what happens next and ONLY if they have not already made that clear to you verbally or through a living will. 

Your parents haven't "already have made them for you", they have made THEIR decisions to make, for themselves. It's a question of who 'owns' the decision making responsibility. You are saying you do, I'm saying they do. IF something is my responsibility, I can't be making decisions 'for you'.


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## sags (May 15, 2010)

They moved my dad from the ICU to palliative care to a hospice and all they did was confirm the moves with us. My mom passed away the next day.

Just out of curiosity, what would they do if they required the right paperwork and you said okay, just go ahead and do whatever you want.


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## andrewf (Mar 1, 2010)

Retired Peasant said:


> Not sure what you are saying Andrew; the discussion was around what to do when a POA for care has been done. It sounds like your grandmother did not have a POA, and of course cannot create one if incompetent. But James is referring to his parent, _who has a POA_ in place. He needs to follow that, if he has been named the POA. He doesn't even know if he has.
> 
> My assumption would be that his other parent has been named (perhaps with him as a alternate (not the same as co-)).


My point is that LTA is arguing that parents are not to be treated like children. Sometimes that becomes necessary because they are regressing with cognitive decline.


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## andrewf (Mar 1, 2010)

Money172375 said:


> I’ve witnessed where the doctors and nurses kept asking....”do you want us to make her more comfortable (ie. ease the pain and increase the meds)? In hindsight it felt like euthanasia.


I often get the impression that "make them comfortable" is a euphemism for euthanasia.


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## Longtimeago (Aug 8, 2018)

andrewf said:


> I often get the impression that "make them comfortable" is a euphemism for euthanasia.


Well I would say no. Generally what it means is they will try to up the meds to the point the patient feels no pain. Generally speaking they offer that when there is nothing more they can do to advance the patient towards recovery. So they are in fact telling you death is inevitable at that point and all they can do is attempt to relieve pain until the end.

They are not suggesting at ALL that they will give the patient an overdose which THEY KNOW will CAUSE death. That would be euthanasia. It's a question of intent. Remove pain or cause death.


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## sags (May 15, 2010)

andrewf said:


> I often get the impression that "make them comfortable" is a euphemism for euthanasia.


I think it is to allow the doctors to provide sufficient pain medication to relieve suffering, even if it causes death.


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## Longtimeago (Aug 8, 2018)

andrewf said:


> My point is that LTA is arguing that parents are not to be treated like children. Sometimes that becomes necessary because they are regressing with cognitive decline.


Yes that is the point andrewf, competent parents are not children. When there is cognitive decline, that is another story entirely but in the case of THIS thread, the parents are apparently fully competent to make their own decisions and yet we have a child talking about making decisions for them. That's insulting. Children are entitled to worry and to care but they are not entitled to treat parents as if they were children. That's the entire point. 

All too often we see threads like this one where people are talking about making decisions for their parents when the parents are quite capable of making their own decisions. In this forum I'm sure there have been plenty of such posts about making financial decisions for parents for example. I earned my money, I can spend it as I wish and I can invest it well or poorly as I wish, it's no one's business but mine.

IF and only IF I ask for advice, then the person I ask is welcome to give me their advice.


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## andrewf (Mar 1, 2010)

Longtimeago said:


> IF and only IF I ask for advice, then the person I ask is welcome to give me their advice.


Funny, given your penchant for lecturing other people on their behaviour (unsolicited).


There is no brilliant clear line between "fully competent" and "incompetent", or at least maybe only in the legal sense. I know my parents are starting to lose their sharpness. Doesn't mean I am making decisions for them, but I give them more and more advice or offers of help. They can be particularly irrational about health stuff. So far it has consisted of my siblings more than me nagging my dad about going to the doctor about various things. He had high iron levels (common for older men) and was not following the medical advice of limiting meat/alcohol, so I got him in the habit of donating blood.


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## Plugging Along (Jan 3, 2011)

andrewf said:


> Funny, given your penchant for lecturing other people on their behaviour (unsolicited).
> 
> 
> There is no brilliant clear line between "fully competent" and "incompetent", or at least maybe only in the legal sense. I know my parents are starting to lose their sharpness. Doesn't mean I am making decisions for them, but I give them more and more advice or offers of help. They can be particularly irrational about health stuff. So far it has consisted of my siblings more than me nagging my dad about going to the doctor about various things. He had high iron levels (common for older men) and was not following the medical advice of limiting meat/alcohol, so I got him in the habit of donating blood.


Very true. Seldom does one go from 'fully competent' to incompetent even in the legal sense when it comes to aging. Unless there is an accident or an event, the deterioration of one's decision making ability come with time and can be very slowly.

We suspected that something was 'off' decades ago with my mom. It was just little things that didn't seem logical or the 'best' decision. We just attributed to my parents wanting to do what they wanted. When speaking to my cousins, our aunts display similar characteristics, along with the grandmother. So again, we just assumed this was upbringing, culture, or different personalities. 

The things got 'odder and odder', and my mom wouldn't listen to us, and was making really bad decisions. We tried to stop her, spoke with the doctors, and lawyers etc. Without taking extreme measures, there was nothing we could do. This had nothing to wanted to take control of their lives, I was so frustrated at times, I wanted to just distance and walk away. She didn't see there was a problem and we couldn't force any help. 

It wasn't until she had her stroke and the behaviors where even more off that we were able to get her the proper care. The doctors attributed her mental ability to her stroke, and we explained the history over the last decades. At the time of her stroke, I had to take over her health decision, and were able to get additional tests that I wanted years ago. They brought in additional specialists and psychiatrists, and found she had a rare condition that probably surfaced 30-40 years ago. If she had gone for help, it would have not have deteriorated to the condition it is now and no longer treatable (just manageable). 

We told our cousins who are younger what we have been dealing with. They are trying to get their parents the testing and help they need, but cannot force it. 

The problem is often an aging person does not realize their abilities are deteriorating. I have already told my kids and spouse what I want which is to call 911 if they are in any doubt. They are young and so am I, but I have already started putting in place checks and balances of if my mental health starts to go since my mom's condition is hereditary. I suspect will not know that I am not able to make reasonable decisions, but will think still can.


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## Plugging Along (Jan 3, 2011)

andrewf said:


> I often get the impression that "make them comfortable" is a euphemism for euthanasia.


Meant to respond. There is a specific level of care (can't remember), but 'Make them comfortable' is fairly well defined. They will treat symptoms of pain or discomfort but not treatments to prevent your from deteriorating. 

It's really important to understand what they will do or not do. So when my mom was given a couple of days or may weeks to live from an untreatable condition, they suggested that her care level be change to 'make the comfortable' (the official code). This would mean that they will not recesitate or try to save her. This made a lot of sense since it was a heart condition that she would die from and any treatment would be painful and futile. The goal is to keep the person as comfortable as possible.

Then when she was still living after two weeks and the hospital needed their bed back, we were able to transfer back to the home. Her coding of 'make her comfortable' stayed. Which I thought made sense, until I understood further. 'Making comfortable' meant they were not monitoring or treating her BP or diabetes as frequently. Even though she was probably to pass anyways, I wanted her to pass from the untreatable condition not from neglect of pre-existing conditions. I had to go line by line in what type of treatment and care. For example, she would not be treated or sent to the hospital if there were signs cardiac arrest, however if she fell and broke something she should go to the hospital.

It's important to know what they will and will not treat. My mom is still alive after a year, and I am pretty sure she would not be if I didn't change her coding.


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## OptsyEagle (Nov 29, 2009)

James. Did you ask them the most basic question. What is their aversion to a ventilator? Obviously, in a perfect world a person would not need one but I can assure you that if I was having a problem breathing and they had a machine that could do it for me (especially as I eventually tired of the effort doing it myself, as all people eventually do) I would give it a thumbs up pretty quickly. Without it I am going to die anyway. Seems pretty irrational and more akin to trying to look brave but not totally understanding the situation they will be in when it is required.

No one wants to put them on a ventilator and some people do survive them. It's not like they will need one forever. If they do they can always pull the plug on it then.


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## andrewf (Mar 1, 2010)

Given that ventilation might be necessary to treat an injury or illness that someone could likely recover from and have years of healthy living left, it seems irrational to fully refuse ventilation. I can definitely understand not wanted to be kept on ventilation if it is unlikely that one would recover, but I don't think anyone should be under any doubts that medical practitioners would be applying significant pressure to withdraw life support in that situation.


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## james4beach (Nov 15, 2012)

That's a good question andrew, and I haven't had a chance yet to get into this deep conversation. But I believe my parent is concerned that the doctors are too quick (with COVID-19) to jump to ventilators, and that permanent lung damage could result. My parent is concerned that the resulting lung damage, which often occurs from ventilators, may be *preventable*.

My parent does not want to die. They want to optimize for their quality of life, and don't want to go into a hospital, and leave with permanent, lifelong injuries.

The good news appears to be that doctors have started using less invasive oxygen support methods, described in this article. The title also captures the issue that I think my parent is concerned about

Ventilators are being overused on COVID-19 patients, world-renowned critical care specialist says



> Garrone says his emergency department now begins with non-invasive ventilation — different ways of getting oxygen into patients' lungs without force, such as a mask or a nasal cannula. This helps people in the early stages of the disease to inhale enough oxygen without damaging their lungs.


Also see: Most COVID-19 Patients Placed on Ventilators Died, New York Study Shows

In other words, ventilators could be the wrong route for treating COVID-19 patients. The outcomes are not great, and the ERs may be too quick to put people onto ventilators.

My parent has legitimate concerns about the health system, and believes that busy hospitals and ERs are quick to use standard tools in the toolbag. For example, one of my best friends is an ER surgeon, and every time I've talked with him he's always talked about their supply of ventilators. The ICUs clearly have a strong focus on using ventilators, and I think my parent may be correct in their belief that *doctors may be too jumpy to get people on the (likely harmful) ventilators.*

But my parent wants a chance to recover on their own without the most invasive measures. They believe the ventilator, with forced oxygen, might cause more damage than it's worth... especially with some of the info coming out from COVID-19 treatments where ventilators were involved.

I'm speculating a bit here, but I think my parent's concern about the ventilator is specific to COVID-19 treatment and not a general hatred for ventilators. They may be fine in other cases.


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## james4beach (Nov 15, 2012)

It seems that this ^ idea I got was accurate. I just had a quick, informal chat with them.

My parent is concerned that the medical community isn't doing so well at treating COVID-19 patients in ICU. The WHO guidance was to put people on ventilators, and therefore, this is what all hospitals will do. Since that was the WHO guidance, that's now the procedure.

But we know many people on ventilators end up dying, so it's not looking like a great path of treatment. See articles I linked to above; 88% of people on ventilators died. There can also be serious long damage or permanent harm from going on ventilators.

My parent believes the WHO guidance and medical community is overusing ventilators, or jumping to them too quickly, and wants to take their chances *without* a ventilator ... but specifically talking about COVID-19 here.


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## sags (May 15, 2010)

It depends on a lot of factors. The decision can only be made at the time.

When I wasn't sure about something, I have asked doctors what they would do if it were them or their dad.

That gives them the opportunity to tell you what they really think is best, but it is still up to you.

Hint....doctors come and go from patients. It is the nurses who deal with it 24/7. Maybe you can draw a hint from them.

Bear in mind that nurses don't make those kinds of medical decisions, but they do deal with the decisions that were made all the time.


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## james4beach (Nov 15, 2012)

sags said:


> It depends on a lot of factors. The decision can only be made at the time.
> 
> When I wasn't sure about something, I have asked doctors what they would do if it were them or their dad.
> 
> That gives them the opportunity to tell you what they really think.



Well, it sounds like my parent has made their decision: don't put me on a ventilator if I end up in ICU with COVID-19. And it sounds like they have good reasons.

Now I should clarify with them whether this is indeed the message under all circumstances? Or could it be different in some cases? I don't know.


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## sags (May 15, 2010)

It seems clear then.

They make the decisions until they can't and after that you don't allow ventilators for COVID. They made their choice and it is out of your hands.

James....the last thing you want is to put them on a ventilator and have them survive with a horrible outcome. That would be worse than granting their wishes.


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