Nearing End Of Life From Breast Cancer

If you are likely to enter a health care facility such as a hospital, assisted living facility or nursing home, choose the facility with care. To learn how, see the links at the end of this article.

If there are circumstances in which you do not want aggressive medical care, your doctor can tell you whether a particular facility will honor your wishes. If a facility will not follow your wishes, there is likely to be one nearby that will. If the medical care is much better at a facility that will not honor your end of life wishes, consider the following steps:

• Execute a Health Care Power of Attorney appointing a Proxy who will be empowered to make medical decisions when you can't. (A document for your state is easy to obtain and is free)
  • Discuss with the person you appoint as proxy what you do or do not want done and in what circumstances. Include an overview of your wishes so he or she has guidance for answering questions that the two of you don’t think to talk about.
  • Be sure that one of requests you discuss with your Proxy is to move you from one health care facility to another if the first one refuses to comply with your wishes.
  • Execute other Advance healthcare Directive documents such as a Living Will in case there is a dispute about your wishes.
• Let your doctor know that you will enter the suggested facility, but that if you reach an end stage, you want to be transferred to another facility that will honor your end of life wishes. Give the doctor a copy of your Health Care Power of Attorney, and the contact information for the person you appoint as Proxy.  Give another copy of the Health Care Power of Attorney to the health care facility. Also give the facility a copy of any other Advance Directives you execute.

If You Have A Partner Instead Of A Spouse: Visitation

Whether your partner is of the opposite sex or of the same sex, hospitals and other health care facilities may treat the person differently than a spouse even though they are not supposed to. As a result, the person you care most about may be denied visitation all together, or visitation may be limited.

To be sure the person can visit when desired, the best approach is to learn about a health care facility's position before entering the facility. If that is not possible, your partner will have to learn how to navigate the system.

As a general matter, hospitals and other health care facilities have a right to determine visitation. Patients do not have a right to be visited. If visitation is permitted, facilities which accept Medicare are not supposed to have different rules for partners than for spouses.

If the person is of the opposite sex, while we don't condone lying, the practical answer may be for the person to say that he or she and you are married. Health care facilities seldom check.

If the person is appointed your Healthcare Proxy, he or she could add conditions when asked to make a medical decision. For instance, he or she could use the magic words "informed consent" and say something like: "I can't make an informed consent on behalf of the patient until I see (him)(her)." There can also be an insistence before the decision is made to have visitation rights with the patient on an ongoing basis to be able to make other decisions as the need arises because of "an ongoing duty in the patient's interest."

For more information, see:

• Advance healthcare Directive documents
  
  • Health Care Power of Attorney
    • What To Discuss With A Healthcare Proxy
  • Living Wills
  • DNR
  • How To Enforce A Living Will And Other Advance Directives
• Assisted Living Facilities
• Nursing Home 101
• Hospitals 101
  

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