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Ask Dr. Gott 12/01
Health-care proxy gives family more options
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DEAR DR. GOTT: My mother-in-law has been confined to a home for dementia/Alzheimer's patients for over four years. She is in relatively good health. She has been given a number of minor prescriptions over the years that were usually not expensive, although one time there was a cream for skin cancer that was costing us $100 a month. I complained to her doctor, and he said she needed it. As someone who has had skin cancers a lot, I have never been prescribed such an expensive medicine, but we got it for her for several months.
    This year he started prescribing Protonix for swallowing at $106.98, Zyprexa for dementia at $59.97 and cephalexin for pneumonia at $21.48 per month, along with all her other medication.
She does not have prescription coverage and does not qualify for Medicaid. The drug store says we are getting a discount.
    She is on a puree diet and has been for years. She gets her flu shot yearly and had pneumonia one time four years ago. We do not want her on the dementia medicine. As per her trust, we have a DNR order on her and, at her request, no life-sustaining measures are to be taken.
    Her doctor will not stop prescribing the medicine even though we have complained repeatedly of the expense and that we don't feel she needs it. His attitude is that if we can afford a private nursing home then we can afford whatever he prescribes. The home will not stop the medicine unless the doctor OKs it.
    My question is, do we have the right to say no more medicine? Do we have the right to control what is given to her without having to switch doctors? I know that if my doctor prescribed something that I didn't want to pay for, I have the right to say no. And I have. He is the only doctor on her insurance plan in the town where we have her, and he says if we don't like what he prescribes we can get another doctor. It seems that once you are under the control of a nursing home and physician, what the family wants is of no matter. Is this true?
    DEAR READER: If your mother-in-law is severely impaired, someone in the family should obtain a health proxy that will legally permit him or her to make medical decisions regarding quality-of-life issues. Once this is in place, her doctor and the nursing home will have to alter their rules to accommodate the family's wishes.
    Assisted-living health-care professionals should be very attuned to what is in the patient's best interests. If you come up against a wall, changing physicians may be an option to consider, but first obtain a health-care proxy.

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