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Nancy Keller

    Client was end stage cancer and started in hospital, still cognizant and making decisions for themselves. They had a medical POA in place. I was called in to help navigate the medical aspects of care. Communication between myself and client was limited as I live in another state, but there were people to mediate.

    After 4 weeks and near the end, they were transferred to a nursing home. The client was on heavy pain meds and going in and out of consciousness. They made their treatment wishes clear to me shortly before the pain got unbearable and, ultimately, lost consciousness. Their wishes had changed since discussing previously with the medical POA, but POA was not privy to that discussion. POA was told of client’s new decision but chose to stick to the original plan made with the client months prior. I appealed to the POA to alter the treatment plan to keep client as comfortable as possible and bring in a hospice team. The POA declined. Final result was that my client had to endure bouts of excruciating pain that could have been prevented.

    Question: Do we have any leverage to go above a POA if we have knowledge of a change in the client’s wishes? It seems like third-party interference to me, but I felt I had no legal authority.

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