I tend to focus on the gear and technological aspects of survival, but occasionally we touch on the all-important mental considerations. I was reminded this week that sometimes survival planning also involves making sure you’ve adequately prepared for even the most unsatisfactory circumstances, not surviving.

www.equipped.org/blog/?p=87

Good one, Doug. Sorry it came to mind they way it did. Condolances.


Consider joining AARP. They offer through cooperating attorneys the full range of legal planning and documents at a drastically reduced fixed rate - typically less than $50 for each document in California. I believe so long as one member of the immediate family is a member, that the rates apply to each of the members of the immediate family. So, check it out and if you or someone close is 50 or older, and can find $10 to join ....

Mr. Ritter, please accept my condolences for your and your family's loss. As always, you give us sound advice. Thank you.

By the way, I'll match the AARP price for advance medical directives (living wills), designation of a healthcare surrogate, durable power of attorney and aimple wills, for members of this forum who are in Florida. This is within my particular field as a healthcare attorney, and I will do more than simply filling out a standard set of forms for you.

I don't mean this as advertising, but just as a favor for friends who have done a lot to help me. If there is any doubt whether this offer is appropriate, I request that a moderator remove it immediately. Thank you.

Jeff

Thanks and thanks for a very generous offer to the forum members in Florida.

Doug,

My condolences.

Preparation helped my mother when she lost her husband suddenly, as well as when my girlfriend died after a long illness. The impact on the families was significantly lessened because of their forethought.

Bill

Doug, my condolences also.

I am going through a similar situation right now. My stepfather is dying of cancer that has spread through his body. I will be going up to Oregon next week to help out. Hospice came out yesterday to assess the situation. He only has a few weeks to go.

I think they are AARP members already. Thank you, Dweste, for that information also.

Thank you for sharing, Doug.

Joy

My condolences to you and your family, Doug. These are events that we all must go through and it is our family and extended family (friends) that get us through the times.

Your family will be in my prayers!

Bo

Sorry about your family's loss.

A word to others out there: if you decide to start making a living will, make sure you understand the legalities in your area about when it does and doesn't apply.

For example, here in Orange County, CA, there's a prehospital EMS DNR form. If you don't have that, you're out of luck. Hospital DNR's don't count, and living wills don't either.

Also, many hospitals won't honor forms from different facilities.

Having the bases covered for these eventualities makes a lot of sense and takes a considerable amount of sting out of an otherwise stressful time.

Most communities have legal advice and assistance available on a low or no-cost service. Some lawyers will advise you of the applicable laws and help fill out the appropriate forms as a community service.

Many hospitals have legal services departments that can help if brought in ahead of time. These lawyers are possibly the most up to date and well informed on the subject and know how to work the system toward any desired outcome in what can be a very complicated area of the law.

The AARP has information and forms available and does some good work in informing the public as to the options and legalities on end of life issues. They deserve credit for that. But I personally can't really recommend anyone join the AARP. Because they are, in essence, an insurance company that caters to people over 50 by organizing and selectively lobbying for them as a way to endear themselves to potential a lucrative customer base.

[Political commentary deleted by Moderator]

Please allow me to respectfully disagree, in part. Low cost or free legal services are often excellent, if you can find them. They often use a sliding scale fee based on income, and please don't think the quality of legal services available there is necessarily less than that available at some high dollar firm. Often, they are far better than some junior associate that you might see at such a firm.

But, as for hospital legal departments, I'd think there may be a potential conflict of interest there. Health care institutions aren't generally in the business of providing legal advice to the public or patients. Their attorneys are ethically bound to represent the interests of their employers only. So I would not count on them for legal advice, and I disagree that they are likely to be the most proficient in this particular area of law, judging by some of the work product I've seen. Moreover, I'd like to hear of it if any hospital is providing such legal advice to patients.

However, hospitals usually do have forms available, without advice, for patients to use. Often, the forms available from various sources can entirely meet the needs of some folks, but sometimes not. I haven't looked at many of the on-line sources lately, but I'm told some of them are excellent, as are some from elder or medically oriented charities. Heresy, I know, but you don't actually need a lawyer for everything.

Also, please be aware that no one can be compelled to provide or sign any such document as a condition of medical treatment or admisssion to a hospital or nursing home. I've known occasions where patients were told or led to believe otherwise.

Nothing in my posts is intended to be legal advice, and is presented for discussion purposes only. Consult an attorney for legal advice specific to your circumstances.

Jeff

An advance medical directive is something entirely different than a physician's "Do not attempt resuscitation" order entered into your medical record once you are in the hospital. They have very different rules. MDinana is entirely correct that a physician's DNAR may not be honored elsewhere, and it will likely to cease having any effect once you are discharged.

But, an advance medical directive, properly prepared and legally sufficient, is a binding legal document. It must be honored at ANY hospital. If some hospital refuses to honor one of my client's directives simply because it's not on their own form, I'll have their posterior in front of a judge so fast their heads will spin, and that's one advantage of having a lawyer prepare the document with you. Mine have my after hours cell phone printed on it for just such emergencies, along with many other provisions covering all sorts of circumstances that I've not seen anyone else include.

Also, because they have neither the time nor the ability to review the legal sufficiency of your advance medical directive in an out of hospital emergency, paramedics in most jurisdictions are trained to simply ignore it, and let the hospital folks sort it out. However, as MDinana correctly points out, some jurisdictions have special out of hospital forms aimed at paramedics. Florida does. Check for this in your jurisdiction.

MDinana gives wise advice to "make sure you understand the legalities in your area about when it does and doesn't apply." The rules can vary in different jurisdictions. I'm not offering legal advice here, just information for you to discuss with your own attorney familiar with your jurisdiction.

Jeff

Doug,
First, my condolences

RE Living wills, DNRs, healthcare proxies etc

They are state specific, and talk with a lawyer. I've gon through this twice in the last 13 months (Mom then Dad). Got to talk to the Hospic folks (GREAT folks- at least around here)

If you have ANY, and I mean ANY health issues - do yourself a favor. Write down your medical history, plus what drugs and dosages you take, plus any medical care instructions (DNRs, proxies, etc) put them in an envelope, with a BIG label "Name's Healthcare info", put in a ziplock bag, and stick it to the front/side of your REFRIGERATOR where it can be seen

The FDNY/EMS crews say "we find you on the floor, unresponsive, the first place we're going to go is to your refrigerator to look for drugs - insulin etc. We'll see that envelope, and be REALLY happy to have it"

I carried a copy of Dad's medical history, his prescription list, all his MD and insurance info and the like on a small slip of paper in my wallet (in like 3-4 point type), plus a copy on my thumb drive. Over the last 6-8 months of his life, as he shuffled in and out of hospitals, nursing homes, rehab centers, etc, the doctors were all so happy that I could hand them that piece of paper. It took care of the immediate needs, and gave them people/places to contact for the more advanced info (like complete records). I can remember walking into the hospital the first time in the whole chain, and the admitting nurse being so happy to get that paper when she started asking medical history questions

I carry a similar slip for ME, easy to find in my wallet, and one for my wife, and the kids that are burried to they are not confused with mine

I am sorry for your loss. But you/he did the right thing. Quality of life, in my opinion, is everything. He had obviously come to the same decision.

Re living trusts, they are indeed great. They do not solve all problems, but they sure do smooth out the road. My parents had one, which really simplified things for me once they were gone. We have one too, but since we just changed state residences, we have to have another drawn up. Thanks for the AARP hint, I did not know that.

Re DNR's, in my experience, there are hospitals, probably all of them, that will only accept a DNR that is on THEIR form. They will ignore anything written by your attorney, or anyone else...

First of all, my condolences to Doug and his family.

I would urge everyone, this being a forum about Survival, to be very very careful how you use terms like "Quality of Life" Honestly, the last thing I'm worried about is being given life prolonging treatment that I don't want. I'm much more concerned about being denied even the most basic care that I do want. They don't call it the "culture of death" for nothing.

From http://www.nrlc.org/euthanasia/AdvancedDirectives/ReportRevised2007.pdf

From a survival perspective, think about how many people in survival situations had an absolute zero quality of life and a zero hope for rescue. Yet they kept on going. How many of us would have judged their lives unworthy of living at the time?

When my Mom had to go into the hospital in the last few years of her life, almost the first words out of the mouths of the people in the hospital were "Do you have a Living Will?"

Maybe I am being cynical beyond all redemption (really?), but I kind of got the impression that they would be perfectly happy not to attempt to resusitate if no one was going to pay for it.

Unfortunately, a few other people going to this hospital chain have gotten the same impression.

I was also told by an attorney in Las Vegas that without a medical power of attorney, NO ONE except a current spouse can make medical decisions. It doesn't matter if you are blood child, sister or father. If you don't have the paperwork, you can't make the decisions that you know the person wanted; the hospital will make them, right or wrong.

Sue

When my mom was dieing in the hospital, even tho we had a living trust, durable power of attorney for health care, DNR, etc etc etc, her dr made me hand write a document, at oh dark thirty, telling him to unplug her. I did it, he did it, next morning he plugged her back in, pretty much all by himself. More money for those twice a day five minute visits to her room for him...

It appears your mother's physician committed criminal battery under state law, a violation of federal law, as well as a huge ethical breach and probably a violation of your state's medical practice act, not to mention possible insurance and/or medicare fraud. Having you write out your instructions was merely prudent, however. That's what I'd advise any of my doctors to do, in any such case.

These posts make it sound that doctors nation-wide are out of control. It worries me.

Jeff

Doug; our condolences to you and your family.





I used a similar approach in Virginia with my Dad and his DNR order. He was at home, in home hospice, and we posted it on the refrigerator door. It was an ugly orange color so no one would overlook it. We also stopped by and talked to the guys in the local EMS squad, and briefed them. They made a note of it in their log book/notes, so even the off-duty guys would know to look for the order in case they responded.

The help of locally knowledgeable folks is invaluable in being sure the documents are accepted and implemented. One resource is your local hospital's medical social worker (may have different title) who probably knows all of the ins and outs and can get you started in the right direction.

For once, maybe Florida is a leader instead of behind the times. Actually, Florida does have some pretty darn good laws in the area of elder rights and protections.

Now, I need to make a clarification. There is a huge difference between refusing to honor the decision of a patient or surrogate just because their instructions are written on the wrong "form" one the one hand, and merely requesting that patients or their surrogates reduce their instructions to writing on a specific form that is familiar to them and therefore easier for them to follow, while fully intending to honor and comply with all of the instructions and decisions of the patient or surrogate, whatever they may be, on the other hand.

As long as they are doing what the patient or surrogate directs, there's no problem with them saying "Okay, we'll do as you say, but please just put it in writing on the form our folks are used to, so there are no mistakes about you want us to do."

We are discussing something very fundamental here, and that is the right to self-determination and to control one's own body and destiny, either for ourself or through another trusted person we've selected to speak for us when we longer can. This is perhaps the most basic right and freedom of all. If that right is not being respected by the medical community, or by your or your loved one's physician, then something, somewhere, has gone seriously wrong. You don't have to take it, and decisive and immediate corrective and enforcement action is called for.

Jeff