End-of-life paperwork in the U.S.?

Miscellaneous and Personal Stuff I Must Share
1

I hope this is an appropriate topic for this category.

A decade ago, my mother (85yo) had emergency abdominal surgery, during which she had a heart attack. By the next day, she had not regained consciousness, her kidneys were shutting down, and the hospital said that if she did recover, she’d be on dialysis.

Her wishes had been clear: no heroic measures. We three kids were all there by this point, and agreed that she would not want anything else done. We told the doctor this, they withdrew the respirator, and a few minutes later it was over.

Note that this was in Ontario, Canada.

My question: How would that have gone down in this country? We signed no paperwork, showed no ID; for all the hospital knew, we were random (insane) strangers ganging up to have them kill this old lady.

I’m not complaining, mind you! It was all very civilized. I just find it hard to believe that in this super-litigious country, there would not have been a bunch of paperwork involved.

Anyone gone through a similar experience, or perhaps as an ER doctor or nurse, first-hand knowledge of the procedure here in the U.S.?

Postscript: After she was gone, they brought in a cart with tea, coffee, and cookies. We kids were all fine with her passing–she’d had enough problems over the years that it wasn’t really a surprise–and so the tea cart was sort of surreal, like “She’s gone, time for a party!” Of course we knew that wasn’t it: if we’d been super-upset, it could have been a very welcome and touching gesture. But since it wasn’t, we all sort of went “Huh?” and still laugh about it.

2

This is not an identical situation, but I’ll just mention it as part of a data point.

My mother went into an apparent coma from insulin shock at the age of 78. My father had brought her out of similar situations with some kind of injection kit he had, but this time it didn’t work, I don’t know why. So he called an ambulance and she was taken to the hospital. They did a neurological examination of some kind and determined that she was not going to come out of it, and so would remain in a coma until she died. She had had a pacemaker installed fairly recently, so at some point my father gave permission to have the pacemaker turned off, and not long after that she died. (This is my understanding of events as they were related to me at the time, some details may have been missed.).

I imagine that on admission to the hospital my father gave all the information and identified himself as her husband. I don’t know if he was asked for any proof of identity. My sister and myself, as well as my aunt, arrived at the hospital the next day, but none of us had any say in the outcome under the circumstances.

I wonder if your mother had anything on her, or on record with her doctor, either naming her next of kin who would have the authority to make decisions, or a durable power of attorney telling the doctors what to do in this situation?

3

Thanks: we had that paperwork, but were not asked for it (my one sister had been handling all of my mom’s affairs for years). Mom had been in a nursing home, but there was no sign of any checking with them for any paperwork, either.

4

My elderly mother and father were both infected with COVID became very sick and were taken to different hospitals (one by my sister and the other in an ambulance).

My sister provided ID to show that she was Ms Eva Johnson (e.g. her married name), but was allowed to discuss my unconscious father’s care with the doctors and nurses. My father’s name (e.g. Ricardo Suarez) gave no indication that he was related to my sister. There was no “paperwork” in place to give her authority to make any decisions or even get information but she was able to do both.

When my brother arrived at the hospital where my mother (conscious, but very weak) was admitted, he had to get some documents FAXED over to prove his bona fides even though his name (e.g. Rodrigo Suarez) at least indicated that he might be related to the patient.

In my father’s case they did ask my sister whether they could intubate him or put him on a ventilator if necessary. Knowing my father’s beliefs and preferences, she said yes to both, but fortunately they did not need to.

We had a whole bunch of legal documents drawn up over healthcare and financial decision-making after this incident.

So it seems like there is no consistency.

5

I’ve been through this a few times with relatives in two states. In all cases, the person had previously signed a Health Care Power of Attorney assigning me as the responsible party if they couldn’t make decisions. I don’t know how it would have gone down if there was no POA in place. For seriously ill people who are expected to die soon but can still make decisions, there is also a POLST form they can fill out in conjunction with their physician which specifies what medical treatment they desire; this is an order from the patient directly to all medical practitioners, without the POA person being involved. A DNR (Do Not Recuscitate) order is similar; I think POLST allows more options while DNR just addresses CPR.

6

When my mother was near the end of her life, she had a DNR order (Do Not Resuscitate) made out and had copies of it in the local health care system, which is shared by the hospital, urgent care type locations, and most doctors in the area.

I also had power of attorney for her.

Either of these alone would have been sufficient. Without a DNR or without someone having power of attorney to say what the patient’s wishes are, the hospital is required to resuscitate the patient.

7

In the US, you wouldn’t even have gotten past the hospital front desk without establishing who you were. I’d have thought that’d be the case everywhere.

And it’s likely that she had also made her wishes clear to the medical professionals, orally, in writing, or both. So it wouldn’t have been a surprise to them when you told them the same thing. They just wanted to be sure there wouldn’t be any surprises.

8

My mother, who was hospitalized with a broken hip which wasn’t healing, stopped eating. I was her health care proxy and she also had a dementia diagnosis, though she was still capable of expressing opinions; they called me to confirm her refusal of artificial feeding and hydration. I confirmed her wishes. I had also previously had to sign DNR (do not resuscitate) forms for her; again in confirmation of her often-repeated wishes.

I’m not sure what would have happened if I hadn’t agreed with her, though I think that because of the dementia they might have overridden her if I’d disagreed.

They already knew who I was. I don’t remember whether at any point I’d had to show ID, or whether my mother’s clearly recognizing me (she was still quite able to recognize people) had been enough. I know they got a copy of the health care proxy, though.

I don’t know what the procedure would have been if she hadn’t signed the proxy forms before she got the dementia diagnosis. I’m glad we didn’t have to find out; it was a lot easier on me to make that decision because she’d been utterly clear for many years about what she wanted.

– other family members did get there before she died, but they didn’t argue about it. For which I am also thankful.

My mother’s death was entirely expected and I was still quite upset; more so than I’d been expecting. Tea and cookies would have been quite welcome. I don’t think it’s reasonable to expect the medical facility to judge how upset people are going to be when the people themselves sometimes don’t know (though I’m not sure whether your reaction was because you thought they could do so.)

They would probably have asked for it on first admittance and kept it on file, instead of waiting until the need was urgent. I was asked to sign my mother’s hospital DNR as soon as she was admitted, though that was weeks before she died. (She was carrying her non-hospital DNR with her, as she’d done for years, but those apparently don’t necessarily work if you’re admitted.)

9

Tennessee has an Advance Directive form. It goes over almost any contingency. I have talked with a lawyer. It should work in any state, as long as it is notarized.

https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.tn.gov/content/dam/tn/health/documents/Advance_Directive_for_Health_Care.pdf&ved=2ahUKEwj--_rW9sD-AhXskmoFHUAzBcUQFnoECB8QAQ&usg=AOvVaw1IWKe5gl9MZJjwHlrxxwR5

10

I live in the US, and that wasn’t my experience. Now, my mother and i were both known to my mother’s doctor, so I suppose in a broad sense the hospital knew who i was. And my mother had a DNR and had made me her healthcare proxy. But I put her in home hospice care over the phone, on my say so. Perhaps her doctor had to fill out a lot of paperwork. I didn’t have to.

11

My father has a DNR plastered to his fridge in his apartment.

It was 1984, but the doctor came to talk to us in the ER about mom. We said no life-support machines. She recovered, but never left the hospital again. We had a DNR in her; her quality of life was so bad that we went for quality over quantity and let her go peacefully…

12

Nor mine. In the case of both my parents, I came in from out of town, and I just asked for the room number and went there, as a visitor. That doesn’t speak to the OP’s main question, but I think Chronos’ assertion needs further support.

13

Not in the three different US hospitals where my mother, brother-in-law, and father-in-law died in 2010, 2016, and 2020, respectively. My mom was unconscious and transported by ambulance; I followed by car and my brother came in about 20 minutes later. Her condition was such that when we told the person at the desk who we were there for, she had us immediately escorted into a private waiting room until the doctor came to tell us the verdict.

My brother-in-law was also transported by ambulance, followed by his dad. We met them at the hospital, and we were allowed to go in to see him in the ICU. His dad couldn’t bring himself to make the call to not hook him up to a ventilator, but they did offer him that decision in the absence of any medical power of attorney paperwork.

In the case of my father-in-law, he had made the trip between hospital and rehab facility twice already, and the hospital personnel knew our family members by sight. We’d already discussed various options when he was still able to communicate clearly, so he’d made his own decisions. I don’t remember if anyone had to show ID at any point in the process.

Now, at other times when a family member was in the ER for something that wasn’t life- threatening, I’ve gotten the third degree and had to prove who I was before being grudgingly allowed back. But when it came down to it, every one of the medical and paramedical staff who helped us was unfailingly kind and human.

14

You might want to be aware that the paramedics are not bound by the DNR and they will do their best to revive the patient regardless of what you say or what paperwork you have. If you want the DNR to be followed by paramedics you must have an Out Of Hospital DNR form which is signed by a doctor.

15

Yes. And then if you go into the hospital you need another one, for that specific hospital. (The existence of the non-hospital one might be taken into account, but there’s supposed to also be a hospital one.)

– I was instructed that if my mother collapsed at my home (or at hers while I was with her) that I should not call 911, I should call her doctor; because if the EMT’s showed up they might feel that they had to try to revive her anyway.

16

This is not true everywhere. The Advanced Directive form for Tennessee should work (in Tennessee), as long as it follows you and medical personnel are made aware of it.

17

It occurs to me that some of my information on this is twenty years out of date (though my own paperwork has been updated more recently than that.)

18

I have always had to show ID to get in as a visitor. I do not have to prove my relationship to get in as a visitor. When my kids were minors, I did not have to prove I was their parent to give consent for treatment, including surgery. And it’s a good thing, because I couldn’t have. Sure I could have spent time looking for the birth certificate that said someone with my name gave birth to someone with their name - but an 8 year old doesn’t have ID so it doesn’t really prove anything.

Aside from that, my mother didn’t need any paperwork to make decisions for my father and she and my uncles didn’t need any for my grandfather. But I am 100% sure that the reason for that was their age and their condition. In neither case was it an otherwise healthy person who had surgical complications or a heart attack or something like that - and my father was 73 and my grandfather 89. Probably would have gone differently if it was an otherwise healthy 40 year old.

19

You’re in NY , right? You need an out of hospital DNR and typically each hospital will ask you if you want a DNR when you are admitted. There’s also a Medical Orders for Life-Sustaining Treatment (MOLST) which is valid in facilities or out-of-hospital and should be transported with the patients.