After Louise Enge’s aunt, Lois Hasheider, had a stroke at age 100, Hasheider was paralyzed and unable to speak. Doctors told Enge the condition was “irreversible,” Enge said.
Hasheider had designated Enge, of Lodi, as her health care agent in a power-of-attorney-for-health-care document. Hasheider had checked a box saying that if she couldn’t “recover my ability to meaningfully interact with myself, my family, friends and environment, I want to have all treatments used to prolong my existence stopped or withheld.”
At Sauk Prairie Memorial Hospital, Dr. Sandhya Shah told Enge she needed to do a swallow test on Hasheider. Enge asked Shah not to do the test, citing the document, which Enge calls a living will. Shah did the test. Shah also gave Hasheider an injection to prevent blood clots, which Enge learned about later from a nurse. Enge thinks Shah shouldn’t have done the injection either.
“What is the purpose of a living will if the doctor has total disregard for the patient’s wishes and does whatever she wants?” Enge asked in a complaint against Shah to the Wisconsin Medical Examining Board.
The medical board took no action against Shah, saying there was a “low probability of successful prosecution.”
But Enge’s question has broader implications. The Wisconsin Medical Society’s Honoring Choices initiative is encouraging residents across the state to do advance care planning, which often includes power-of-attorney-for-health-care documents.
So, why bother, if doctors do what they think they should do anyway?
Julie Short, a Madison attorney who helps clients complete power-of-attorney-for-health-care documents, said she had problems when her father was dying from cancer at a hospital in Green Bay. Short, her father’s health care agent, said she had a hard time getting doctors to stop doing tests and procedures.
“They kept wanting to do stuff, and it hurt him,” she said. “It was a real eye opener.”
Power-of-attorney documents are useful, however, Short said. If patients become incapacitated and need to move to hospice or a nursing home, the documents can prevent a complicated court guardianship process, she said. “Without them, you have no power,” she said.
Still, health care agents must be assertive, Short said. “The burden is on the agent to keep at it,” she said.
Dr. Tim Bartholow, chief medical officer of the medical society, said that if a power-of-attorney document is up to date and it is clear the patient reflected about his or her desires, doctors should follow those wishes. If the patient is incapacitated, doctors should listen to the health care agent, Bartholow said.
“We have a moral obligation to hear them,” he said.
Sometimes, however, seemingly dire medical conditions are reversible and the wishes expressed in a document are unclear, Bartholow said. “We have to do in-the-moment decision making,” he said.
Shah told the medical board the swallow test was needed to see if Hasheider could receive nutrition, though Enge said a hospital official told her it was to see if her aunt could receive pain medication. Shah said the injection is routine for people with prolonged immobility.
“In my professional opinion, it was my duty to provide her best care possible,” Shah said in a letter to the medical board.
Hasheider died in 2012, three days after arriving at the hospital. Enge said she and her aunt previously had positive experiences with the hospital. But the disagreement over Hasheider’s end-of-life care still bothers her.
“It made me feel sick and betrayed,” Enge said. “Her dignity was not respected.”
0 comments:
Post a Comment