Living Will/DNR Order

By Vicrgreen Latest Reply 2009-09-03 20:55:39 -0500
Started 2009-09-02 01:00:30 -0500

Do you have a Living Will and a Do Not Resuscitate Order in your files? My mother does. I just got back from visiting her in Fairbanks where I found that she has pneumonia. The facility called an amublance for her (she is immobile on her own power) and had them take her to the ER. She had been diagnosed with pneumonia and had taken the full prescription given her by her doctor. And yes I realize given isn't really the right word. At any rate. When she got to the ER they put in an IV for fluids but refused to "treat" the problem because they have a DNR on file. When she talked to her doctor about all this and signed the Living Will and he did the DNR she thought, as did I, that it meant that if she died they were not to try to bring her back but they absolutely refuse to treat her, other than bringing her fluids back up which was certainly not the intention of either of us.

She is currently back at the facility. Where they are giving her fluids, she is on oxygen, and they have her sitting up in a recliner. Not much else they can do at this point.

This is the second time this has happened. Unfortunately now that the DNR and Living Will are on file they won't let her change them and she is in no condition to force the issue, short of hiring an attorney, which we can't afford to do.

The way the Fairbanks hospital works if you are in their facility you have to use their doctors. They won't even attempt to reach her own doctor.

At this point the doctor wants her to come in to his office, which would necessitate calling an ambulance to take her there, which the lady in charge of the facility does not want to do. She had to leave town with another one of the "guests" who is currently in a coma in Anchorage and so is not on hand to deal with Mom's situation in person. They have an excellent staff but there is little anyone can do when everyone just keeps harping on the DNR order.

All of which is to say, if you have those things you may not want them in your files but in the hands of your family, friends or a caregiver who can put them in force when the need arises. I tried to talk to the hospital but I didn't get any more satisfaction than the folks from the Care Center did.

It is a sad fact of life that sometimes what you intend is not what you get. And the sadder thing is, I believe, it will only get worse under the proposed reform.

19 replies

Vicrgreen 2009-09-03 20:55:39 -0500 Report

I appreciate all the excellent advice and will go about taking advantage of it as soon as possible but my main reason for posting was to let people on DC know it could happen to them. You can't protect yourself if you don't know a threat exists.

I have a general POA, which our attorney said was better than a durable because it did all that a durable did but covered other things as well.

Bless you all for your compassion and advice. It is valued.


BeckyJ 2009-09-03 18:25:52 -0500 Report

Sorry to hear that you have had sich trouble with this. Currently my mother is in the process of updating her POA and Living Will. She is "required" to do so by the hospital that is considering her for liver transplant. She is very hesitant to sign the papers because of situations like this. Her current POA just states that either my Father or I are capable of making legal decisions in her absence. Her living will is a general one stating she did not want "extrodinary measures" taken to prolong her life. She will be on a respirator following the transplant so she MUST have a new Living Will otherwise they are unable to do the surgery. All of the legalize has her confused. All she knows is that she doesn't want to be on life support indefinately. I wish you the best of luck in making sure your mother's wishes are met and that everyone resposible for her care is aware of her true wishes.

beadmom 2009-09-03 17:24:05 -0500 Report

Here is the Alaska Living Will and the Alaska Durable Power of Attorney link from HALT. It is a pretty straight forward document.

I would hand-write on it somewhere that the signing of this document renders invalid any previously dated signed Living Will, Power of Attorney for Medical Decisions and/or Do Not Resuscitate Order and make sure that is initialed.. Also get it notarized.


Bekki Diabetic
Bekki Diabetic 2009-09-03 17:50:07 -0500 Report

The wording in the first sentence of the Living Will is the reason Vic's mother was not provided any service to cure her pneumonia. They were saying she was going into Congestive Heart Failure and, therefore, would not do anything to prolong her life. I would not sign that Living Will. It also mentions DNR and donating organs. The only thing she needs is a good POA giving her daughter the right to speak her desires. Make several copies of the signed document and give copies to other relatives or friends so others know her wishes and it shows when she signed it. Another thing that helps a caregiver is to be put on their checking/savings account in the event they needed money for the patient. Then you don't have to worry about waiting to be added later.

beadmom 2009-09-03 18:09:33 -0500 Report

Yes, but it conforms to the Alaska state guidelines (which has to be kept into consideration) and it could only be brought to light if needed.. Not filed with a hospital.. Which makes it at the discretion of the holder of the POA.

Frankly I agree about getting a good POA and about the financial POA as I just went through that and it was a nightmare to try and get done after the fact (stroke) Getting two doctors and a notary in ICU was a magic act in itself let alone getting them to declare a man competent but incapacitated and then getting the POA signed.

The main thing is to get something to rescind the standing order.

Yikes. this is like working off the clock but much more rewarding.


Bekki Diabetic
Bekki Diabetic 2009-09-03 18:53:24 -0500 Report

Working off the clock!! That's funny…and you are right when you say it's more rewarding. I have always thought that a durable power of attorney is the best thing for everything. After working in a hospital, it really concerns me because there are people who change their minds when it comes right down to the wire but they have a Living Will on file. Everyone should have someone who can speak for them (I know that is not always possible). Sad.

beadmom 2009-09-03 19:26:03 -0500 Report

It is sad.
I'll tell you, my brother and I sure learned a lot that week after my Dad had his stroke. We both went home and did POAs for us and our spouses.

I am afraid were I in Vicrgreen's situation I would need legal counsel…to bail me out after those handgun charges…


Vicrgreen 2009-09-02 21:36:07 -0500 Report

Fairbanks Memorial Hospital (FMH) is the only hospital in Interior Alaska. Her doctor doesn't practice at a different one because there is no different one. If you don't want to go to FMH you have to go to Anchorage, where there is more variety.

I should say that I have a Power of Attorney (POA) for my mother and have had for more than 10 years. We just assumed that with that I would have some say in how she was treated. Wrong again.

Last winter I got a call about 4 AM from the Assisted Living Facility (Wild Iris Comfort Care) where Mom lives. They said the ambulance had just left to take Mom to the ER and that I should call over there. I did. The person I talked to took my phone number and said they would try to figure out what was happening and if they had any questions they would get back to me. It was more than 60 below that night and I didn't wanat to start out to go to Fairbanks if there was nothing I could do to further the situation so I agreed to wait. I didn't hear anything for a couple of hours so I called again. I got the ER doctor who told me that they had decided that she was going into Congestive Heart Failure, that the normal treatment for that was to insert a catheter in the groin and run it to the heart and drain the fluid that was causing the problem. Did I want them to do that? Yes, I did. Should I come in, were there papers to sign? No, I didn't need to come in the call was being recorded and it would serve for the time being.

About 2 hours later I got a call from Wild Iris. They had sent Mom home. They had not done the catheter, they had not put her on oxygen (she couldn't catch her breath and was panicing), they had not given her any antibiotics. Nothing. No treatment. By good fortune the lady who runs Wild Iris was able to get her doctor on the phone and he was able to call in a prescription for antibiotics as soon as a pharmacy was open and he ordered an oxygen concentrator for her, which she has been on ever since.

I called the hospital with smoke coming out of my ears. Why hadn't they treated my Mother? Because there was a DNR order on file.

Now, I'm not generally considered stupid and neither is Mom but we both thought that Do Not Resuscitate basically meant: If I die don't do anything to bring me back. We didn't realize it was going to mean don't treat my problem at all.

One of the things that makes things tricky is that Mom is not alway functioning on all cylinders. When she gets into one of these medical nightmares she sort of goes away and doesn't deal with it. I suspect that they would justifiably say she wasn't mentally competent to rescend the DNR order, but there was nothing we had authorized, as far as we knew, that said don't take care of me while I still have a fighting chance of surviving this situation.

Now it has happened again.

I think that tomorrow I am going to call her doctor and suggest that if that is how the DNR is going to be treated it should be pulled from the file. I guess they would let him rescend it, but am not sure. I also think I may call the hospital administrator and tell him what has now happened twice in his hospital and tell him if the files are not modified so that DNR means DNR not don't treat he can expect a lawsuit if their failure to provide treatment leads to her death. I don't know what else to do.

I foolishly thought that the POA would add a layer of protection but that apparently is not the case here. I guess when you have the only game in millions of square miles you can pretty much make your own rules and they do.

Bekki Diabetic
Bekki Diabetic 2009-09-03 08:47:07 -0500 Report

I am really sorry you and your mother are having to deal with all of this. If you read your POA and make sure you have been given all rights to speak for your mother, in all aspects, this should be all you need. If so, I would then show it to the hospital (if dated after the directive/DNR) and have those at the hospital removed. I am curious as to how they worded her directive/DNR. I am sure because they said she was going into Congestive Heart Failure they would be cleared but SHE didn't, did she? The only thing that was done was to send a very sick woman home, unable to breath/choking, making her evening extremely scarey until her physician was able to get her oxygen and meds. What has happened to compassion? Makes me wonder if our country is headed towards euthanasia.

beadmom 2009-09-03 11:25:01 -0500 Report

Yep…I would, if possible, get your Mom, while she is in a competent state, to rescind that DNR. Make a private one for you to keep and present if needed.
Otherwise they are going to kill her and suing after the fact is painful, expensive and too late.


Vicrgreen 2009-09-03 14:24:00 -0500 Report

I just talked to the folks at Wild Iris and they said she had a good night and seems stronger today. The owner is back in town and that will make a big difference.

The POA was done 10 years ago.

I haven't been able to get through to her Dr who is part of a big clinic in Fairbanks. I'm going to keep trying.

Thanks for all the encouragement. This is a very trying time. I feel that it is a harbinger of things we will be seeing much more of if the current Health Care Reform goes through as proposed. I read the bill and it scares me, it really does. I posted a link to it on the Insurance discussion board.

Right now I'm having this problem, soon many of us will be.


beadmom 2009-09-03 15:25:58 -0500 Report

I appreciate you sharing all of this with us. It will make me more aware of what I should and should not be doing in regards to my parents/family members.


Bekki Diabetic
Bekki Diabetic 2009-09-02 16:07:25 -0500 Report

You also need to find out what hospital your mother's doctor goes to and have the ambulance take her there.

I am appalled that they would not allow her to change her mind.This is very, very scarey.

Bekki Diabetic
Bekki Diabetic 2009-09-02 15:57:31 -0500 Report

A living will is one type of advance directive. It is a written, legal document that describes the kind of medical treatments or life-sustaining treatments you would want if you were seriously or terminally ill. A living will doesn't let you select someone to make decisions for you.

By creating an advance directive, you are making your preferences about medical care known before you're faced with a serious injury or illness. This will spare your loved ones the stress of making decisions about your care while you are sick. Any person 18 years of age or older can prepare an advance directive.

People who are seriously or terminally ill are more likely to have an advance directive. For example, someone with terminal cancer might write that she does not want to be put on a respirator if she stops breathing. This action can reduce her suffering, increase her peace of mind and increase her control over her death. However, even if you are in good health, you might want to consider writing an advance directive. An accident or serious illness can happen suddenly, and if you already have a signed advance directive, your wishes are more likely to be followed.

You may change or cancel your advance directive at any time, as long as you are considered of sound mind to do so. Being of sound mind means that you are still able to think rationally and communicate your wishes in a clear manner. Again, your changes must be made, signed and notarized according to the laws in your state. Make sure that your doctor and any family members who knew about your directives are also aware that you have changed them.

If you do not have time to put your changes in writing, you can make them known while you are in the hospital. Tell your doctor and any family or friends present exactly what you want to happen. Usually, wishes that are made in person will be followed in place of the ones made earlier in writing. Be sure your instructions are clearly understood by everyone you have told.

You should review the advance directive that your mother signed and then investigate the laws in Alaska. Find out what is necessary for your mother to change or revoke the one on file. When you come into a hospital, the hospitals are suppose to offer you forms if you do not have one on record. When I was doing them, I always told our clients to keep a copy and also carry a reduced copy in their wallets in the event of an accident. In Alabama and Florida you are able to change your directives at any time (as long as you have the mental capacity to do so).

A do not resuscitate (DNR) order is another kind of advance directive. A DNR is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. (Unless given other instructions, hospital staff will try to help all patients whose heart has stopped or who have stopped breathing.) You can use an advance directive form or tell your doctor that you don't want to be resuscitated. In this case, a DNR order is put in your medical chart by your doctor. DNR orders are accepted by doctors and hospitals in all states.

I am very concerned for your mother (as I am for all seniors) because she should be allowed treatment if she tells the physicians. I have worked for both attorneys and hospitals and it seems to me, her rights are being denied. This is exactly why I have never submitted one to a hospital or physician. It scares me that someone I do not know could actually make a decision for me.

Hope your mother is feeling better. Good luck!

beadmom 2009-09-02 16:29:59 -0500 Report

"A living will doesn't let you select someone to make decisions for you."

That might depend on the state.
My dad has a living will. He had a massive stroke last month. His living will designates me as the person in charge of his medical care. (I wish this had not been a complete surprise).
He also has on it stuff like he doesn't want to be on extended life support etc.

The issue we also had was that he had only been married for 3 days. All of his SSI $$ goes into his personal account. They had set up a joint account but not transferred the direct deposit yet. that left his wife without access to funds she would need to handle their bills. It took some sorting out and real knowledge of the legal system and ways to get around it for me to get things workable for them in a week’s time.

I highly recommend a power of attorney on file for someone you trust, in our case we got one for both myself and my brother as well as my new step-mom as her health is not the best either and designating both my brother and myself as well has her made it so we wouldn't have to go through the whole thing again if something happens to her, and neither my brother or I have to shoulder the whole burden of handling things out of state if need be we can divvy up the work.

hbkunkel 2009-09-02 14:38:20 -0500 Report

Wow this is an eyeopener for me because I had my dad in anassisted care facility and I will have to look into what exactly would take place if a similar situation should take place. Thanks for this eyeopener.

Harlen 2009-09-02 14:25:05 -0500 Report

I have a living will but not a DNR
what I opted for was no extream mesuers to prolong life
My wife is a CCRN and has power of atterny in this case and can overide anything she thinks is to much for this to tale place I need to be unable to comunicate. good luck and I hope she get better soon

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