<p>My H has been asked by his life-long friend to be his medical power of attorney, or something like that. This is a guy who he has been friends with since they were five years old and now they are both in their late 40s. His friend had his tongue and part of his face removed because of cancer, which has now spread to his brain and he has about 7-8 weeks to live. He does not like his siblings (and I believe the feeling is mutual) and is divorced. His kids are 18 and 14. I think he wants my husband to be the one to make sure his medical wishes are carried out, as far as I can understand. Since the guy cannot talk he writes things down, the hospice nurse speaks it over the phone to my H, and then H responds, etc. </p>
<p>The only experience we have with POA is when we closed on a home mtg when H was out of town for business and I had to sign all the docs for both of us. </p>
<p>What sort of responsibilities could my husband be looking at? </p>
<p>DrDrewsmom, my sympathies on the illness of your H’s friend. It must be difficult for all concerned.</p>
<p>The type of responsibilities your H might face include: what heroic measures to take in the event of incapacity, organ failure, etc (otherwise known as “when do you pull the plug”). Would the patient want a feeding tube in the event of irreversable coma; how about assisted breathing? Is there a DNR (“do not recusitate”) order in force? At what point do you put a DNR on the chart? If the patient were in unrelenting pain, how much pain killer is enough? How much is too much?</p>
<p>I am neither a physician nor an attorney, but I have some familiarity with these issues (and no one else has responded yet). Many of these issues can or should be discussed with the patient in advance, in order to ascertain the patient’s own views. This takes some of the burden off the friend/family member. If your H and the patient are not on the same page in terms of end-of-life views, it could be a big burden for him. On the other hand, obviously it is of great value to his friend to know that these decisions will be in the hands of someone who cares about it.</p>
<p>thanks, hayden, for the reply. I guess I am just wondering if my husband will actually have to be physically present for anything. His friend lives in western WA and we live in eastern WA (about 4.5 hour drive). Although the friend is scheduled to be brought to a hospice in our area in the next couple weeks, presuming he holds on that long.</p>
<p>In many states it is referred to as a Patient Advocate, although it is also called a medical Power of Attorney. Hayden’s description of the powers granted is basically correct. Many health care providers insist on a copy or they request that the patient execute their form at admittance.</p>
<p>I would suggest that H’s friend consult a local attorney to prepare the form in strict accordance with his wishes. Your H should also be consulted in regards to the powers being granted so H is sure that he is comfortable with the decision-making that is being put in his hands. I would strongly suggest that H’s friend also prepare a will and trust, if he hasn’t already done so.</p>
<p>A power of attorney means you (the attorney in fact) can step into the shoes of another person and take action as if you were that person. The actions you take on behalf of that person are binding on that person. You act as a fiduciary meaning you are supposed to act in what you believe to be that person’s best interest. Your responsiblities are defined soley by the document. It is important that the power of attorney be drafted by an attorney. Simply pulling forms of the Internet will likely result in disaster.</p>
<p>My brother and my father did this for several elderly friends. You want to be sure you understand clearly the persons wishes and then in some cases you will have to be prepared to fight for them. In one case, my brother’s friend specifically had a DNR and wanted to die at home. My brother got a call that he had been hospitalized and had to fight like heck and get a family friend who is a lawyer involved to fight the situation. He prevailed.
Also as stated above, a lawyer should be involved. Particularly when there are siblings and an ex spouse in the picture…</p>
<p>As a hospice nurse, I agree with what advice has been given above. If the friend is on hospice alot of the decisions about his care have already been made. By choosing to go on hospice your friend has chosen care aimed at keeping him comfortable and not there should not be an issue about DNR status or keeping him alive on machines, as long as the poper forms were filled out.(He could ask about a POLST form, a bright green form signed by the patient or POA and the doc, stating the patient’s wishes on CPR, antibiotic use, feeding tubes and ventilators. It gets put up in a visible place in the patient’s home so that emergency services know what the patient wishes and then they are allowed not to start CPR even if they are called.)</p>
<p>It would be good to make sure that everyone understands who has Medical POA and that the family does not have decision making powers. I have seen situations where the family did not know they did not have POA and it can get sticky. Your husband does not need to be physically present, though it would be good it he could meet with the hospice staff and I am sure his friend would love to have him visit if at all possible.</p>
<p>Mini said it perfectly.
I am a Hospice medical director, and the only issue I can see arising for your H and friend is if the family steps in and tries to start interfering with the patient’s care or decisions that have clearly already been made by him, given that he is in hospice. The patient has autonomy in making his decisions, and the medical team is ethically bound to respect and carry out his wishes. When he is no longer able to do so, your H will be his surrogate decision maker. I would guess that no family interference will occur as it is uncommon, but I have seen it happen. When it does, we try to make any problems with family “invisible” to the dying patient, and handle it with discretion with an eye towards our one goal- allowing that person to die pain free, with dignity.
I applaud your H for agreeing to this important role, since he is giving his friend peace of mind at the end of life. I suspect your H will not have to make many decisions, since as mini said, being in hospice already assumes the main ones have been made. The hospice team will be able to handle the details of his care.
I wish your H’s friend great comfort and peace.</p>
<p>our goal is to meet the patient’s physical, social and spiritual issues at end of life. We will deal with the patient directly as long as they are able to communicate but frequently the patient’s health will deteriorate to the point where decisions will have to be made for them by the POA such as extra medical equipment or oxygen, private hire caregivers to administer medications, change bed linens, turn patient when they are not responsive enough to help themselves. We keep the POA alerted to family issues if we start to get multiple calls from estranged family members who suddenly appear and wonder who is going to get grandma’s china. Then we alert the POA at the time of death and make sure that (hopefully) already planned funeral arrangements happen as planned. The POA role is very important and a testament to how much your husband’s friend trusts him to carry out his wishes and make the tough decisions as needed.</p>
<p>I just had DrDrewsdad read this and he was grateful for the info. There is one sister of the friend who might make things difficult, so it’s good to know what he could be facing. </p>
<p>He is going this weekend to visit and I think there is an attorney involved. I’m guessing that H will sign whatever needed at that time.</p>
<p>How did your H’s visit go? I hope he and his visit had a good visit. I have been thinking about you all. Let us know if he or you need other advice.
Ellen</p>
<p>thanks Ellen.
DrDrewsdad left early Saturday morning and drove over with my MIL (who has also known the friend for 40+ years) to visit. He just got home last night. He said that his friend decided not to do the POA thing after all. He is not in good shape at all…probably weighs about 100 lbs and his entire face is swelled up. Needs a lot of sleep, etc. </p>
<p>The funeral plans are to be in our town when the time comes. He grew up here and his dad is buried here so that is where he wants to be buried too.</p>
<p>H’s friend passed away yesterday. I just wanted to thank those who responded to this thread. </p>
<p>Also I have a question. The funeral is scheduled for Monday and we are thinking of inviting the family/friends to our home afterwards. Is there are name for this type of gathering? Reception? We may have some finger foods and cookies and coffee; that type of thing. So I don’t want to call it a buffet or luncheon (as I don’t want to go overboard with cooking). The funeral is scheduled for 11am.</p>
<p>Perhaps an announcement can just be made at the end of the funeral/service stating that family and friends may visit directly after the after the funeral (or whatever time you desire) at…your family’s name and address. That is a very nice gesture.</p>
<p>Very sorry about your husband’s loss. In Judaism, the meal you are describing is called the “meal of condolence” where the community gathers with the mourners to comfort them as they begin the mourning process. Perhaps the term would work for you as well.</p>
<p>hugs to you drdrewsmom
I think that is very thoughtful of you to host something for family and friends
it is traditional- but I don’t know what you would call it
reception sounds fine- I think people probably know it isn’t going to be a “party”, but they will appreciate the chance to share and tell stories
( and to sit down after traveling over the pass)
If you have pictures of things of his friend when he was healthier to show that might really be welcome as well.</p>