UNUSUAL PATIENT -POA

  And this is an another story on  Unusual POA , power of attorney, for the medical decisions. I had known Sheila for few years. She had bronchial asthma and was doing very well . My office follow up was every 4 to 6 months as her asthma was fairly stable. But this time when I saw her she did not look happy. She told me that she was not feeling well. She was waking up at night and could not fall asleep again. She was not short of breath, but fell tired and had no desire to do any thing. On physical examination her blood pressure was normal and her lungs sounded clear, So I was not sure as to the reason for her complains . As I started to ask her further , she suddenly started crying. On further asking I came to know the whole story.
   She was living with her boy friend for the last 18 years. Never got married or thought . This was partly due to her bad experience with first marriage. She was 49 years old and he was 55 years .He had cardiac arrest and collapsed . She called 911. and the paramedics came in He was admitted to Intensive Care Unit . Unfortunately he was in the coma and in spite of being supported on respirator he was found to be all most brain dead . The decision was made to consider withdrawal of life support , so called 'pull the plug ' Per the state laws if patient can not make the decision then the spouse has the   right to make the decision . If there is no spouse then the children are allowed to make the decision . If there are no children then the parents are in the line , and if they are not there then is the turn of siblings . This all can be avoided if patients makes his wishes known , and appoints some one , relative or friend or any one .
    In this case my patient had no relationship with other relatives, and in fact had some strained relations with the brother. Unfortunately since Sheila and her live in friend were not married and had made no written appointment , she was ' no one ' and her opinion was not to be taken in to account. The decision was made by the  brother r and she was not asked any opinion . This had caused the mental anguish and distress and had made her feel bad !