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Has anyone explained how hospice works, that it isn't giving up but rather living the best possible life until the end? Even those with dementia have autonomy of their bodies, what does your mom want?
Would sister read Atul Gawande's book Being Mortal?
I would be very unhappy with putting my mom through that, but I do understand the emotions that run high when someone approaches EOL and some of the family refuses to let their LO go 'down' without a fight.
There is no dignity in chemotherapy. It's horrible, even when you are younger and in good health. I would never do it again and have written my will so that I WON'T have to do it again should it return and I'm not 100% there, mentally. My POA knows what I do and don't want.
You need to talk to sis, and mom if she's capable. Since sis is invoking POA--my guess is mom can no longer make her own healthcare decisions.
Be gentle with sis--I'm sure she struggled with this decision. Once she sees how very, very sick a 90 yo gets on chemo--she might make a 180 and have her quit it.
Gently approach sis about Hospice. At this stage of mom's life, it is probably the kindest and best choice.
This is a good reason for us ALL to write into our POA/advanced health directive exactly what we will NOT have without having given express permission (chemo, any nutrition per IV or other tube, etc.) Truth is that is the Mom is no longer able to make her own decisions then the Sister is simply prolonging her death a bit and the result with be a torturous if prolonged life. I am certain the doctors at some point will make that clear. If not, and if she chooses not to choose hospice, I would make it clear gently and sadly that the torment and pain she is assigning to your Mom at end of life is hers to bear, and your Sister's to witness. I would find it difficult to forgive, if understandable.
My Moms medical POA read like a living will. As Moms POA your sister should be carrying out Moms wishes. I read a little on this and it seems chemo can give them a little more time maybe even cure but that does have a lot to do with the spreading. If the chemo doesn't really buy her a lot of time, I may not do it. I would wonder what the side effects would be. If there will be pain and a lot of discomfort, I would not put her through it. People suffering from Dementia get like children. A little scratch is something very painful. Not sure if they feel pain more or its just the reaction to pain. My Mom hollered when they put a pressure cuff on her.
Again, POA is to go by the principles wishes. If Mom's POA says no to extrodinary measures, then u don't do chemo.
I would question whether or not a POA authorizes medical treatment. Typically POAs or DPOAs are for financial, real estate, and nonmedical activities. A Living Will or Medical POA would authorize decisions on medical treatment. Your sister actually may not have had the authority to authorize treatment.
Beyond that, assuming you and your sister are on good terms, I would try to get information from the oncologist on (a) prospects for chemo slowing advance of the cancer, and (b) estimates for length of life. Discussing side effects on a 90 year old woman would also be a primary topic of conversation.
I assume you're concerned that you (and apparently your sister) don't have legal authority to contact the oncologist. Can you convince your sister to participate in a conversation with the oncologist so both of you can discuss your mother's prospects simultaneously, despite the fact that there apparently isn't a medical POA document in iplace?
When my mother was D'X'ed with breast cancer, my sister, father and I discussed it with my sister's gynecologist, who also D'X'ed my mother and made our decision not to put Mom through the horrible ordeal of chemo at her age, which was then in her mid-80's. Mom just took Tamoxifen, and lived another 2 years w/o the scorched earth treatments chemo entails.
None of us had any legal documentation to do so, but the gynecologist wasn't a stickler for legal documentation, and my sister had already been treating with her.
An advance directive grants medical POA powers to someone, and there are also POAs that specify exactly what tasks the person can handle, including medical if the person so chooses.
You might try pointing out that the chemo will likely kill your mother faster than the cancer itself. It's barbaric to subject someone of her age to chemotherapy.
Even though your mom is quite elderly at 90 years of age, that doesn't mean that she can't decide her own healthcare decisions. Is she in her right mind or does she have dementia and needs someone else to do the thinking for her? She does not need to be on chemo at her age 90. Your sister needs to be made to understand this. As a cancer survivor yourself maybe she will listen to you and what your experiences were and realize that to put a 90 year old through such an ordeal is wrong.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
Would sister read Atul Gawande's book Being Mortal?
There is no dignity in chemotherapy. It's horrible, even when you are younger and in good health. I would never do it again and have written my will so that I WON'T have to do it again should it return and I'm not 100% there, mentally. My POA knows what I do and don't want.
You need to talk to sis, and mom if she's capable. Since sis is invoking POA--my guess is mom can no longer make her own healthcare decisions.
Be gentle with sis--I'm sure she struggled with this decision. Once she sees how very, very sick a 90 yo gets on chemo--she might make a 180 and have her quit it.
Gently approach sis about Hospice. At this stage of mom's life, it is probably the kindest and best choice.
Again, POA is to go by the principles wishes. If Mom's POA says no to extrodinary measures, then u don't do chemo.
Beyond that, assuming you and your sister are on good terms, I would try to get information from the oncologist on (a) prospects for chemo slowing advance of the cancer, and (b) estimates for length of life. Discussing side effects on a 90 year old woman would also be a primary topic of conversation.
This is a start for also researching the issue:
https://www.foundationforwomenscancer.org/gynecologic-cancers/cancer-types/primary-peritoneal/
I assume you're concerned that you (and apparently your sister) don't have legal authority to contact the oncologist. Can you convince your sister to participate in a conversation with the oncologist so both of you can discuss your mother's prospects simultaneously, despite the fact that there apparently isn't a medical POA document in iplace?
When my mother was D'X'ed with breast cancer, my sister, father and I discussed it with my sister's gynecologist, who also D'X'ed my mother and made our decision not to put Mom through the horrible ordeal of chemo at her age, which was then in her mid-80's. Mom just took Tamoxifen, and lived another 2 years w/o the scorched earth treatments chemo entails.
None of us had any legal documentation to do so, but the gynecologist wasn't a stickler for legal documentation, and my sister had already been treating with her.
Is she in her right mind or does she have dementia and needs someone else to do the thinking for her?
She does not need to be on chemo at her age 90. Your sister needs to be made to understand this. As a cancer survivor yourself maybe she will listen to you and what your experiences were and realize that to put a 90 year old through such an ordeal is wrong.