From: anita@ut-emx.uucp (Anita Cochran)
Newsgroups: sci.med
Subject: Re: stomach tube
Date: 25 Aug 92 18:53:57 GMT
Organization: The University of Texas at Austin, Austin, Texas

In article <1992Aug20.203726.20514@linus.mitre.org>, pdsmith.mitre.org (Pat Smith) writes:
> You need to determine if this feeding tube is a temporary helper for a 
> problem or if her condition is so deteriotiated that this is permanent.  She
> can get adequate feeding by IV and yes it is expensive.  Hospitals are 
> constanly being pushed by insurance companies and probably given incentives to
> do certain things.  Your options really depend on the type of insurance she
> has and your negotation abilities.  I suggest you contact an attorney and 
> investigate living wills. 
> 
> The idea of living wills is for an indiviual to make their wishes for
> treatment known but the laws vary from state to state.  Its a said state that we are in when we 
> treat our animals more humanly than people.  I just watched my mom die of 
> cancer and thankfully her living will was well written and I had no trouble 
> with the hospital over respirators and things to prolong her suffering.  They
> honored the living will and she passed with a certain degree of dignity.


Having gone through similar things in the past year, let me add what I 
have learned from all of this.  First I should state I have no association
with the medical profession except as a consumer.  But it has been an
intensive year with my dad.

As I understand it, as of October 1, 1991, whenever you check into a hospital
they must ask you if you have a living will.  Most hospitals around here
have a generic one you can fill out if you so choose.  However, be warned
that your signature needs witnessing by 2 people who are not related to
you and who do not work for the hospital.  One hospital said they ask
people in the waiting room if need be.

If the patient is capable of thinking clearly, they are the one who must
sign this document unless there is a durable power of attorney.  Thus,
the family cannot make such decisions for a relative who is coherent against
the patients wishes.  I suppose in some states the courts can intervene.  They
should not be able to countermand a legitimate living will.

If you have an elderly relative who might not be able in the future to make
such decisions, a reasonable approach is to draw up a durable (as opposed
to temporary) power of attorney.  The procedure will vary from state
to state.  In Texas, you file it (notarized signatures) with the
county court house in the county of residence.  The power of attorney
must specifically mention medical things for it to be valid for medical
decisions also (otherwise it can be used on bank accounts, etc).
Do NOT keep the power of attorney in your safe deposit box since you may
need it when the bank is not open.

All this said, when my father was in the last stages of life, things didn't
work as outlined.  He had refused to discuss the concept of living will 
throughout months of checking in and out of hospitals.  I think the idea
is if you don't deal with it then death cannot happen.  Several times we
would try to discuss a living will and he ignored it by stating he had a
will.  He was an attorney and certainly knew the difference but would
not deal with the living will.  

About a week prior to his death, the doctor finally got through to him that
the subject had to be discussed.  He made clear to the doctor
that he did not want heroic measures.  The family also made clear to the
doctor that we agreed and would not fight this.  Thus, Dad signed no
living will but a DNR (do not resuscitate) order and no more tests order
were put on his chart.  He even refused a gastric tube though he was
vomiting and that was okay.  He was on IV nourishment.  Except for one
query from a nurse about suctioning some fluid, the hospital never even
tried to violate the DNR or lab tests order so things went as desired.
I assume, but am not positive, that this was perfectly legal without
a formal living will.

Dad died a month ago in a small hospital in Round Rock Texas (outside
of Austin).  This hospital is competent for many things but certainly
is not cutting edge.  However, as there was nothing anyone could do
for him medically, this hospital was a blessing.  It was small and caring
and everyone knew him and cared.  He died around midnight Sunday and the
nurses who treated him Sunday called Monday morning to check his progress.
The hospital was flexible and gave him anything he wished.  He sat out
in the sun on Saturday.  On Sunday when, in his incoherence, he wanted
to sit up and eat lunch at 3pm, they got him the sandwich he wanted within
10-15 minutes.  He by that time had run out of interest but that would not
happen in a big hospital.

There is no dignity in death from a prolonged illness but most of us
will not go in our sleep.  However, Dad's death showed me that there can
be as much dignity as possible in a hospital setting and that the
medical profession (especially nurses) can be truly compassionate.

-- 
Anita Cochran   arpa:  anita@astro.as.utexas.edu  
                       anita@binkley.as.utexas.edu  
                snail: Astronomy Dept., The Univ. of Texas, Austin, TX, 78712
                at&t:  (512) 471-1471