in an emergency where life or limb is at stake you don't have to seek consent to treat unless it has been documented ahead of time from patient or POA to refuse certain things
contact ethics
I had quite a bit of ethics education built into our curriculum, most docs do it all wrong
if the patient has advanced directives, those take precedence over anything the POA says!
doesn't just have to be a form, and there's some judgement that goes into if expressed wishes still apply
say during a PCP visit only 2 months ago, while healthy and of sound mind, gramma says she wants to be DNR/DNI and no feeding tube
has a bad MI & stroke, and gorked, now son is healthcare POA and wants feeding tube
most of the time I see the docs cave to to the family wishes, and they are lucky that gramma usually is so gorked she can never wake up and sue them
the right thing here in this case is not to do what the son wants but what gramma documented, however, there is more legal risk from the son than gramma here, although you would win
keep in mind too that family wishes do NOT override the judgement of the physician in the following:
palliation/reduction of suffering
medical futility
cases where it is clear they are not acting in accordance with what the patient would want
that means if she's AMS but is crying in pain, and the family for whatever hippy reasons doesn't want you to give her morphine, they can suck it
theoretically if she's full code but you deemed it medically futile you wouldn't have to code her, but no one plays that way because of lawsuits
even ethics will back down on that one even though technically the law is behind you
last example, say patient was Jehovah's witness, and so was family, but this admit had a GI bleed and said they renounced all that and wanted a blood transfusion, and even got a few, and that if they needed more they wanted more
now they're gorked and the POA wants to say no
in this case, they can suck it
I come off here like I don't care about what families want and I totally do, but my responsibility is to the patient first and I'm so sick of seeing patients suffer needlessly when the law and ethics are behind us doing what THEY want, yet we condemn them to suffer in all sorts of ways while the family who doesn't have to go through it dictates the torture because of whatever they have mixed up in their heads
too many families aren't able to act as an actual proxy for the *patient's* wishes and think it means they just get to make whatever decisions they want
also contact ethics, it's tough but POAs can be removed even
the whole reason families get to be POA is the idea they *know* the patient better than the docs and can be a voice for what the patient wants
there is usually law in whatever state dictating who is POA, like it often goes to the spouse first, then eldest child, then parent
say gramma has had a live in boyfriend of 4 years
and her son, has been in estranged for 20 and lives across the country, but now he flies in
there are precedents for going before a judge and changing the POA, a lot of times it's the medical team helping to make that happen
keep in mind, there are medical decisions that ONLY lie in the hands of the physician
e.g. whether or not gallbladder removal is indicated (patients don't just get to have them out because they "feel" like it)
sometimes docs give the families more choice than is medically, ethically, or legally warranted (like instances of futility)
not every healthcare choice is actually appropriate to put before the POA
there are things you need to consult with them on, and things you don't!
I could be wrong on some of this, it's been a while since we had "ethics" rounds, can't hurt you to take my post and run the points by your ethics team
#ethicsknowledgeispowertodorightbythe*patient*
