Dear Virginia
I have a brother who is 95 years old. He has been in a nursing home for years now, and he made a ‘living will’ a while ago but, despite this, the nurses keep giving him antibiotics to keep him going. He says he wants to die but, even though he had pneumonia recently, they insisted on medicating him to get well. The nurses just say they have to do this, but is there anything we can do to help him on his way, just by withdrawing treatment next time he gets ill? He has told me he is longing to die, and I feel so sorry for him.
Yours sincerely, Emma
Virginia says
The problem with “living wills” (or Advance Decisions, as they are now known) is that they are couched in variable terms, and some forms are better than others. And anyway, they need to be regularly re-signed at least every three to four years. Very few people are aware of this – they sign them and then forget them, thinking that now they’ve addressed the grisly issue, it’s all fine and they don’t have to go there again. But that’s no good. Doctors who, for religious reasons, want to keep patients alive can, if the living wills are too old, often ignore them. But they are legally binding if up to date. The best version can be got by downloading the form from compassionindying.org.uk
The problem with nurses is not just that they fear for their jobs if they don’t keep pushing sustenance and medication down people’s throats – and also that some may have religious beliefs that put them at odds with withdrawing treatment – but they also, perhaps because they’re not yet old enough, may have no concept that anyone, even someone of your brother’s age, could actually be in a position to accept death as a natural part of life.
An elderly friend of mine, who had signed a living will and had constantly told people of her desire to die after a certain point, was woken every two hours when she was dying by nurses eager to feed her soup and water, despite her daughters telling them that she didn’t want anything and she was ready to go.
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But the strongest way of ensuring that treatment is withdrawn is to have a Lasting Power of Attorney, which would give someone your brother trusts, such as you, the legal authority to make decisions on his behalf. They are more effective but far more expensive, as they involve a lawyer and have to be endorsed by a court.
Still, in principle, with a Lasting Power of Attorney, if a doctor doesn’t follow the guidelines then he can be taken to court himself for not doing the right thing.
I’m slightly surprised, though, that your brother doesn’t simply refuse to take the pills. It is unlikely that anyone could force him to take them, though I agree that if he is ill it might be difficult to put up resistance. But surely you are around and can explain your brother’s feelings to the people concerned? And perhaps get other members of his family involved?
Anyway, if that’s not possible, then there is no reason why your brother, once he has recovered from his most recent illness, can’t, at this stage, summon his solicitor and get a new Advanced Decision drawn up, or a Lasting Power of Attorney, and make a new request to have his treatment withdrawn at a certain point – assuming that he is perfectly sane.
Readers say...
Get the right consent
You should look into taking out a Lasting Power of Attorney for Health and Welfare, which is a legal document allowing the attorney to make decisions about the healthcare and welfare of the person.
The forms can be downloaded from the Office of the Public Guardian or by phone. The law in Northern Ireland is different and a solicitor might be needed to help with arranging an Enduring Power of Attorney. I am in the process of setting up this LPA for my husband, who has dementia.
Julia Worth
by email
His wishes should be paramount
Nursing homes vary widely, but the practice you describe is common, distressing and wrong. You don’t say whether your brother retains capacity or not. In some ways, it doesn’t matter: his wishes should be paramount in either case. But the way those wishes are conveyed differs. If he retains capacity, his spoken wishes should suffice, with his Advance Decision and your account as evidence that these wishes are long held. If he has lost capacity, his previously expressed wishes, the living will, and your account should all be evidence of what he would want if he falls ill.
The nurses may take the view that if antibiotics have been prescribed by a doctor they have no discretion in administering them. In one sense, they are right – but this opens to the door to discuss the prescriptions with the relevant doctor.
In another sense, they are wrong. Neither doctors nor nurses are entitled to insist on administering treatments that their patients explicitly refuse (either directly or via a living will), except in well defined circumstances. Medical professionals who go against clearly expressed views without justification lay themselves open to professional discipline and legal sanction.
I’d suggest that you discuss with your brother a request for a meeting with the relevant doctor and the nurse in charge, to discuss this and to make plans for any future episodes of illness. Your may be able to elicit advocacy services via the local council, to assist in such a meeting.
You may also wish to look at the provisions of the relevant capacity law in the part of the UK where your brother lives. The law and associated regulations are complex, but there are leaflets available in hard copy and online that are designed for ease of understanding by patients and relatives. The nursing home or your brother’s GP may well have some available.
Dr Stephen Potts
by email
Next week's dilemma
My daughter has fallen in love with a very unsuitable man who, I fear, belongs to a cult. She gives him her salary every week and I think he give most of it to this cult’s leader. She is now talking of moving to India with this man, and I am worried that I may never see her again. My husband and I are thinking of trying to employ someone to kidnap her so she can be brainwashed back again – because I feel sure that is her problem. Despite everything we say, she insists that she wants to stay with this man and take on his beliefs. I am desperate. What else could we do?
Yours sincerely, Fiona
