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laws around removal of PEG feeding tube
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Unfortunetly, I need some information please.

If someone had a living will but the POA authorized a PEG tube be inserted. Say this is based on a Doctors advice and comment that it could easily be removed and the prognosis was unknown and the need to try and give them a chance to survive it had to go in.

After some months the person did not have a meaningful recovery and was left dependant on the tube what are that Patient's or POA's rights for getting it removed?

Can the patient demand it be removed?
Cant the patient demand not to be fed thru the tube?
Is there a liability for a caregiver respecting there wishes?

Where can I get some answers on this issue any suggestions?
 
Posts: 10 | Registered: November 30, 2008Report This Post
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If this is a real situation, I would suggest first discussing it in depth with the doctor; get a second opinion if you have doubts, questions or simply want the diagnosis and recommendation for a PEG verified. An attorney specializing in elder law issues in your state could best address the legalities, especially of removing it after insertion...

If this is a hypothetical situation, think long and hard about the PEG. Why does the doc want one inserted? What is the age of the patient? Is this going to be temporary? Is the patient afflicted with AD, ALS or a dementia-producing condition? Does the patient have a terminal diagnosis? Has the patient previously expressed a desire NOT to have a PEG? In the case of an accident or other condition where the patient could reasonably be expected to recover their ability to swallow, that would be a different matter...

If the patient is of sound mind, it is their right to refuse treatment of ANY kind. Using a DPOA to force treatment that is unwanted by the patient (especially if they have a Living Will and have stated they do not want their life prolonged by artificial means) is generally not considered to be ethical.

With so little information to go on, it's hard to say much one way or the other...

I saw your other posts, cfoam, and see your dilemma. When My own mom hadda car wreck in '99, she was on a PEG because she was also on a respirator. Once her injuries improved and she was weaned off the breathing machine, the PEG was removed as she regained control of her swallow reflex. It IS par for the course to insert a PEG for stroke victims whose swallow reflex has been damaged or diminishes during rehab. The key is whether it is being used as a support treatment to feed her while she recovers, or if it's being used as an artificially life-prolonging device. Sometimes, it's a tough call!! If there is no problem removing it (especially if hospice is called in), it might be just the assist needed to help keep her nourished and hydrated while she recovers.

This message has been edited. Last edited by: Moms_Buddy,




"She ain't heavy; she's my mother."
Mom got her wings 11/18/2008
 
Posts: 4691 | Location: SE LA | Registered: August 12, 2004Report This Post
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The key is whether it is being used as a support treatment to feed her while she recovers, or if it's being used as an artificially life-prolonging device. Sometimes, it's a tough call!! If there is no problem removing it (especially if hospice is called in), it might be just the assist needed to help keep her nourished and hydrated while she recovers.


The issue is I don't think she would have ever wanted it. She wouldn't allow it for my Dad but his situation was very different.

Yes, the reason she has it is to assist while in recovery cause "everyones stroke is different and you never know" but how long do you give that? "It was a bad one" Her swallowing has got better but she really doesn't eat more than a few bites. It seemed to get better then the runs hit and it is back to only a few bites. I've tried working with dietary to change the feedings (bolus or all night)or even reducing them to see if her appetite would improve but then the runs hit. (like it was going straight thru her!) She is loosing energy and weight to be able to do therapy and seems to be getting spacier every day. Now on the phone she is parroting what I say. Which was on and off before but now seems constant. It's also hard because I am not there. It's been 4 months now since the stroke.
I think she would be getting better care at the hospital if this continues and told the FAM that but - no action was taken - lets wait and see - FOR HOW LONG? Its taken 2 weeks just to get all the people over there to KNOW she has the runs. If things keep up getting the tube removed might not be an issue. When you say if hospice come in - I am being told she doesn't qualify since her illness in not terminal. Of course that's not what the Hospice people say... Seems everyone has a vested interest.

She does have a living will and the POA authorized it on the Dr's saying it was needed to give her a chance.
 
Posts: 10 | Registered: November 30, 2008Report This Post
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To qualify for Hospice care under Medicare, her condition must be terminal, so if her condition isn't considered terminal, no hospice.

When you say POA - are you talking DPOA - there's a difference... DPOA is for health care decisions as well as legal/financial stuff and tough to revoke, while a POA is for legal/financial matters only and is usually pretty limited in its scope and can be recinded at any time...

If there is a sibling with a DPOA, their directions will take precedence over any other relative because they have been directed by the patient to handle those decisions.




"She ain't heavy; she's my mother."
Mom got her wings 11/18/2008
 
Posts: 4691 | Location: SE LA | Registered: August 12, 2004Report This Post
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Thanks

Seems a catch 22. Currently they don't seem to be resolving the issue with the runs. If a patient has the runs for more than 2 weeks shouldn't they send them back to the hospital?

It's really affecting her recovery and the plan was to use the tube temporarily only - not long term. If she can eat but doesn't want to is it fair to sustain her life with the tube? Is she not eating because of the runs? I mean the stuff has been going right thru her!

It is a DPOA, and they hadn't even read it, clueless as what to do. I had to demand they go read it over again and only then did the DNR go into affect - after I forced the issue. I think that was after having signed for the tube.
This just sucks.
 
Posts: 10 | Registered: November 30, 2008Report This Post



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cfoam Im curious what does the Living Will state?
Is there a reference anywhere in there about feeding tubes?
If so what?


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Posts: 6042 | Registered: February 07, 2006Report This Post
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Originally posted by Bunnys_grl:
cfoam Im curious what does the Living Will state?
Is there a reference anywhere in there about feeding tubes?
If so what?


Unfortunetly, it is not that precise. I don't have the Living doc here but I do have the power of attorney for healthcare which they had and this is what is says:

" I do not want my life to be prolomged nor do I want life sustaining treatment to be provided or contined if my agent believes that the burden of the treatment outweigh the expected benefits. I want my agent to consider the relief of suffering, the expense involved and the quality as well as possible extension of my life in making decisions concerning life-sustaining treatment"


After meeting with a case manager recently she gave me a different form that outlines everything. Got it for free... The other non-specific one cost Mom lots more from the attorney!!! Thanks guys. That is one learning from all this. Have a specific document that has multiple scenarios. Feeding tube, Respirator, life support, etc

After talking to others I found out that even if you say you want certain things in your POA doc, your DPOA doesn't have to respect them legally!

What a crock of a system we have egh?
Run me over with a steamroller so there is no question.
 
Posts: 10 | Registered: November 30, 2008Report This Post
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