Is there no such thing as a Living WIll in the Uk? Is it called an 'Advance Decision' which isn't legally enforceable, only offering 'suggestions' to those in power over care?

Has anyone done one? This is for someone who does NOT have psychiactric problems or dementia etc. However was admitted to hospital with Acute confusion due to stopping medication for physical disease.

Is it wise or necessary then to do a power of attourney?

I thought that was for when person lost their marbles.

Best

Clear33

Hello there.

What is it you're trying to achieve please?

I have power of attorney for my mother which she had drawn up. Now she has been diagnosed with dementia, the power of attorney has been invoked and I can control her finances. She did another one for health and welfare too.

I know you can have a short term power of attorney, but the person would normally be expected to set that up before they went into hospital.

Tell us more please.

HB

Is there no such thing as a Living WIll in the Uk? Is it called an 'Advance Decision' which isn't legally enforceable, only offering 'suggestions' to those in power over care?

 

 

Has anyone done one? This is for someone who does NOT have psychiactric problems or dementia etc. However was admitted to hospital with Acute confusion due to stopping medication for physical disease.

Is it wise or necessary then to do a power of attourney?

 

 

I thought that was for when person lost their marbles.

 

 

Best

Clear33

They are indeed described as "advanced decisions" on the NHS website, though I've usually heard of them discussed as "advanced directives".

http://www.nhs.uk/Planners/end-of-life-care/Pages/advance-decision-to-refuse-treatment.aspx

They ARE binding on the medical staff WHEN correctly formulated, for E&W : the law is less clear for Scotland / NI.

Often the issue is discussion on if the person was competent to make the directive, and precisely what is ruled in or ruled out, and when : the MDU (see below) describe this as "applicable to the circumstances" when discussing validity.

"no ITU" seems pretty clear, but does that mean "No CPR",

(There is little point in doing CPR as part of the "chain of survival" if ITU would likely be needed after, if "No ITU" is mandated)

What then if it is "no emergency lifesaving measures"?

Sure that pretty much rules out CPR, but what if the patient was way better, soon to be discharged from hospital, and started choking whilst eating their meal?

Do they really mean "I don't want backslaps to relieve choking"? If they do want backslaps, if those fail, is the Heimlich manoeuvre allowed or not??

The GMC has issued guidance on their binding nature

http://www.gmc-uk.org/guidance/ethical_guidance/end_of_life_binding_advance_refusals.asp

The MDU issued illustrative guidance in 2011, Discussing the issue in primary care (pages 11-13)

http://www.themdu.com/~/media/Files/MDU/Publications/Journals/Good%20Practice/Good%20Practice%20April%202011.pdf

OP, is there an advance directive or power of attorney that predates the hospital admission?

If not, if the patient is competent to give a lasting power of attorney (including the power to make healthcare decisions), they are likely competent to make an advanced directive.

If they aren't competent to make one, they likely lack competency to create the other. If the hospital is refusing to accept a NEW (since admission) advance directive on grounds of competency : it is unlikely they would accept a power of attorney instead.

I note "This is for someone who does NOT have psychiactric problems or dementia etc. However was admitted to hospital with Acute confusion due to stopping medication for physical disease." : are the hospital saying "they were confused, and are still too confused to be competent to make such a decision"?

As a baseline : do they know who they are, where they are, and the date ("orientated in time, place and person"), although if they've been in hospital a while it's easy to loose track of the exact date as all the days seem the same.

(You know you've been in hospital a while when you don't know the exact date, but do know it is Friday as "today's menu is Friday's menu from the week 4 menu" : which I once overheard as the reply from a very non-confused (but long stay) patient).

If they aren't fully orientated, or there is discussion of if they are / remain confused : ask if they've had their "mini-mental score" tested

http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=121

If it comes down to an argument regarding competency : ask for an opinion from a consultant psychiatrist.

Thanks.

I will need to digest the information and will be back

No, the patient is perfectly competent, remembers all clearly.

Thread moved to the correct forum.

Thanks.

 

 

I will need to digest the information and will be back

 

 

No, the patient is perfectly competent, remembers all clearly.

Hello again.

It would be helpful if you could tell us what you're looking to achieve with this please and can then hopefully point you in the right direction.

HB

 

No, the patient is perfectly competent, remembers all clearly.

Glad to hear it. Just be prepared (especially since they were admitted with confusion) that the medical team might not agree.

If there is disagreement : I've posted above on a possible way to get it resolved.

Sorry site team and thanks for taking the time to move the thread to the correct forum.

BazzaS - still not digested all the info yet - but didn't want to leave it any longer to say thanks very much. Yes, 'confusion' is one of those things that can snowball on your records. However this was some confusion that she was aware of amongst clarity and it has fizzled out upon starting medication (not psych med). I guess like b12 deficiency. And I think, to my knowledge, medics accept this. She is sharp as a Gillette.

Honeybee - thanks for your concern. what was I trying to make sure of? Truth, clarity, a person centred approach, not getting pushed around by a poor system and should any decisions have to be made - that they are made in their best interests without any conflict of interests. I am certain you do a wonderful job for your Mum.

Very Best,