Patient: "God Cured Me!" Judge: "You're having a hysterectomy anyway"

[Qadgop_the_Mercotan]

@WhyNot

We’re taught that Advance Directives and DNR orders trump Medical Power of Attorney. That is, the PoA can allow or disallow anything as long as it does not conflict with the AD or DNR. Is this not correct? (Or is this one of those School vs. Real World issues?)

Once the POA is activated or a Guardianship is in place, those DNRs and Advanced Directives are lovely guidelines, but the POA/Guardian can (and on occasion does) decide to revoke them, ignore them, etc. Just as the individual can decide to change their mind about them. The POA/Guardian replaces the individual’s judgement when the individual is deemed incompetent.

And in actuality, a Guardian is obliged to base their decisions for their client on what is most likely to prolong life, not what is most congruent with the patient’s wishes. That bit of info came as quite a shock to me, when a professional Guardian pointed it out, along with the relevant statutes.

[zoid]

So if I wanted a DNR to remain in place no matter what would it be best to simply not appoint anyone POA?

[Qadgop_the_Mercotan]

@zoid

So if I wanted a DNR to remain in place no matter what would it be best to simply not appoint anyone POA?

No, make damn sure you trust your POA to do what you want them to do.

Otherwise you could end up with a guardian who will opt for life over other choices.

[DoctorJ]

I had a somewhat similar situation with a new patient a few years ago. Little old lady pushing 70 with the usual–diabetes, high blood pressure, osteoporosis, arthritis, history of coronary disease, etc.

Her daughter caught me in the hall before I went in and explained that I was the sixth doc they’d been to in the last two years. She said that I could talk all I wanted about her mother’s blood pressure and everything else, but I could NOT suggest that she had diabetes. A preacher had prayed with her and told her that her diabetes would be cured, and she insisted that it had been. Furthermore, when her previous physicians refused to accept that her diabetes was gone she wouldn’t go back to them.

Labs from a month before showed a blood sugar of around 300 and a HbA1C of 13. (That is, she has diabetes, and it’s bad.) Her kidneys were also starting to go south, and she had signs of nerve and eye damage–all sequelae of poorly treated diabetes.

Near as I could tell she was a perfectly intelligent and competent woman otherwise. She managed her own meds, and knew what they were all for, so there was no treating her on the sly.

I decided to go along with it for the time being. Good blood pressure control is as important as sugar control in diabetes, so I figured I could at least do that. But she must have smelled my skepticism, because she never came back.

Another elderly patient who lived alone swore to me that she was taking her medicine, but her blood pressure and such didn’t seem to be improving. I convinced her to let me do get a home occupational therapy eval so someone could get a peek at her situation, and the OT found all of her meds dumped into a bowl on her nightstand. The patient told me that she asked God when she woke up every morning if she should take her meds, and if he said yes she just grabbed a handful and took them. She seemed to realize as she explained this that it really wasn’t right, and she didn’t object much when I suggested a nursing home.

As to the OP situation, it occurs to me that this woman has not seen her cancer. She has seen blurry images that they tell her is cancer and lab results that she is told suggest cancer. Experts have explained to her that she has cancer, and that all the scientific evidence says she has cancer. But why should she believe them? They’re not smarter than God.

She’s been told that the “scientists” and “experts” are wrong about things like evolution and global warming, so it’s hard to turn around and insist that she accept the similar word of experts when it comes to her body.

All ethical issues aside, in my experience it is nearly impossible to get surgery done on a patient who doesn’t want it done and is able to tell you so. Giving meds to an unwilling patient is one thing, but when you’re strapping someone down and knocking him out and he’s begging you all the while not to do it, hospital lawyers will appear out of nowhere and put a stop to it.

[Grumman]

@WhyNot

Now we’re deep into the “is religion delusional”? debate, one on which mental health professionals have become tapdancers with more skill than Fred Astaire.

Sure, because they’re cowards. Would claiming that little green aliens spoke to you and promised they would cure your cancer be a delusion? Then so is claiming God spoke to you and promised He would cure your cancer.

A delusion is a persistent idea not shared by one’s culture or religion. Now that she’s changed her story, of course, it’s hard to call it a delusion, because many religious people share the belief that God can cure them, and a delusion, by definition, is a belief not shared by one’s culture or religion.

A delusion, by definition, is a belief held despite the balance of evidence being against it. It has nothing to do with how many people share the delusion, unless the individual only holds the belief because they are being lied to.

[WhyNot]

@Grumman

A delusion, by definition, is a belief held despite the balance of evidence being against it. It has nothing to do with how many people share the delusion, unless the individual only holds the belief because they are being lied to.

Nope, not in mental health evaluations, it’s not. The cultural and religious escape clauses are definitely in there:

Delusion: A false personal belief that is not subject to reason or contradictory evidence and is not explained by a person’s usual cultural and religious concepts (so that, for example, it is not an article of faith). A delusion may be firmly maintained in the face of incontrovertible evidence that it is false. Delusions are a frequent feature of schizophrenia.

The current DSM has elected to use the word “subculture” instead of religion, but in a practical sense, it’s the same thing, since a religion *is *a subculture:

A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everybody else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person’s culture or subculture.

[Eva_Luna]

@Jackmannii

By the way, survival in stage I cervical cancer (while depending on the degree of invasion) is at least on the order of 80-90% over a five-year period if properly treated. Once it’s metastasized, 5-year survival drops to under 20%.

This was the first thing that jumped to my mind. I had Stage 1 cervical cancer 8-1/2 years ago, was treated with a 20-minute outpatient procedure under local anasthesia that did not, obviously, involve removal of any reproductive organs, and have been fine ever since. How do we know that the only logical treatment is something that will leave the woman unable to bear children?

They haven’t given enough medical info here for anyone to judge, but a perfectly sane person might think that a radical hysterectomy was not the way to go even if preserving fertility weren’t a consideration, no?

[Eva_Luna]

ANd here the American Cancer Society breaks down the cervical treatment options by stage of cancer.

Note how even in some cases in which radical hysterectomy is considered the standard treatment, other options are presented. Why is nobody discussing that the patient should have some input into which treatment option is chosen? Why is the court taking the advice of a single doctor?