BajaNomad

Discussion of end of life care

EnsenadaDr - 9-26-2013 at 10:03 AM

I received a U2U from a member of this forum who has a family member who has a very serious illness and the Mexican Doctor has forbid all family members to tell the patient. The member wants to know if this is Mexican law or not. As far as I know no Mexican law states a family member cannot inform someone of a life-threatening or terminal illness. In the United States, the US Medical Board Exam in fact states that you MUST inform the patient of their condition, unless they have been deemed incompetent to make life or death decisions (i.e. decisions concerning continuing treatment, such as dialysis), regardless if the family wants to tell the patient or not. The doctor should tell the patient first about their illness directly and not sugar coat anything. The doctor in this case probably does not want to upset the patient, fearing the information could weaken the patient's condition further. But it is clearly disrespecting a competent, alert and oriented individual their rights to full knowledge of their diagnosis and denying them the right to plan or discontinue treatment with the knowledge they will receive. I would inform the patient if the family feels that is the right move.

[Edited on 9-26-2013 by EnsenadaDr]

DavidE - 9-26-2013 at 10:08 AM

Is this posed in form as to be a question?
Your local ministerio publico representing the state of B.C. would have the definitive answer to this if it is a question regarding the law.

motoged - 9-26-2013 at 10:08 AM

Doc,
This will be an interesting thread :wow:

I think that they should get a new doctor and diagnosis....if they get the same diagnosis, at least they will have a more professional and ethical practitioner who respects the patient enough to be honest....if I have a month to live, I want at least 29 days notice....not 4. :cool:

elizabeth - 9-26-2013 at 10:37 AM

Assuming an adult conscious competent patient, what right does the doctor have to give medical information to anyone other than the patient (unless, of course, the patient has given consent).

EnsenadaDr - 9-26-2013 at 10:40 AM

Well David I am almost 100% certain that MD's down in Mexico are in charge of their own patients as to informing them about life-threatening or terminal illnesses. I have never had a doctor tell me they were going to consult the law about what to do with a patient, at least in Mexico. And as for informing the family about a terminal illness, there is no law saying you cannot do this. It is up to the discretion of the doctor.
Quote:
Originally posted by DavidE
Is this posed in form as to be a question?
Your local ministerio publico representing the state of B.C. would have the definitive answer to this if it is a question regarding the law.

EnsenadaDr - 9-26-2013 at 10:42 AM

The ones that don't want the patient involved in their own care or decisions. It's not easy to tell someone they are very sick or have a terminal illness.
Quote:
Originally posted by elizabeth
Assuming an adult conscious competent patient, what right does the doctor have to give medical information to anyone other than the patient (unless, of course, the patient has given consent).

durrelllrobert - 9-26-2013 at 10:46 AM

Quote:
Originally posted by elizabeth
Assuming an adult conscious competent patient, what right does the doctor have to give medical information to anyone other than the patient (unless, of course, the patient has given consent).


Janean wrote:
"..the Mexican Doctor has forbid all family members to tell the patient.."

Sounds like the family members already know but the patient doesn't

EnsenadaDr - 9-26-2013 at 10:56 AM

Yes Bob that is the case.
Quote:
Originally posted by durrelllrobert
Quote:
Originally posted by elizabeth
Assuming an adult conscious competent patient, what right does the doctor have to give medical information to anyone other than the patient (unless, of course, the patient has given consent).


Janean wrote:
"..the Mexican Doctor has forbid all family members to tell the patient.."

Sounds like the family members already know but the patient doesn't

DavidE - 9-26-2013 at 11:48 AM

"I'll never forget that insufferable bastard in Washoe Medical Center in Reno Nevada that refused to tell me outright that I had Acute Myleogenic Leukemia. He hemmed, he hawed. He refused to tell me or even offer a discourse about how "long" I had. Pertinent, succinct questions.

Finally after having his "chastised" eaten raw, he yelled.

"You have about eight months without treatment. Now, are you satisfied?!!!"

EnsenadaDr - 9-26-2013 at 12:09 PM

David I did a little more investigation on the "laws" and found the IMSS patient's rights which in actuality are very similar to the American Patient rights. The three violations of these rights in the case of the patient that does not know her diagnosis are the following:

Información precisa, oportuna y veraz sobre tu diagnóstico, pronóstico y tratamiento.
Precise, timely and truthful information about your prognosis, diagnosis and treatment.

The patient discussed in this post does not have a diagnosis, prognosis or treatment plan because the physician has not discussed it with her.

Aceptar o rechazar el tratamiento o procedimiento terapéutico que se te ofrezca.
The right to accept or reject the treatment or therapeutic procedure that is offered to you.

Since the patient is not aware of the diagnosis, the patient does not have the right to accept or reject the treatment or therapeutic plan.

La confidencialidad de la información que proporciones a tu médico.
Confidentiality of information pertaining to the patient that the doctor is aware of.

As Elizabeth mentioned, the patient/physician confidentiality bond has been broken because the patient's information was given to the family first and not the patient.

I listed the IMSS patient rights on a separate post for future reference.
Quote:
Originally posted by DavidE
Is this posed in form as to be a question?
Your local ministerio publico representing the state of B.C. would have the definitive answer to this if it is a question regarding the law.

toneart - 9-26-2013 at 01:12 PM

I cannot speak to Mexican law, but ethically, the doctor is doing a grave disservice to the patient. It is his diagnosis and it is his life! Furthermore, you have stated that he is lucid and competent.

I cannot believe that the family would be prohibited by law. Why don't they disobey the doctor and tell the patient? If it is too delicate or difficult for the family to do this, then they should prompt the patient to confrontationally grill the doctor to directly and fully reveal his condition. I would also convince the patient to go elsewhere for a 2nd opinion/diagnosis.

You have not said whether the patient is a U.S. citizen, or if the family who U2Ud you live in Mexico.

If they have a home in the U.S., they should tell the patient and bring him/her there and seek the options available. If the condition has been diagnosed as terminal, then get him enrolled into Hospice. That will provide the patient with palliative care; to gain the best possible quality of life for the time remaining; to keep him pain free and comfortable, at home.

I am a Hospice Volunteer and can speak with full confidence as to what a wonderful organization it is. They are also very good at counseling the family and even providing respite for the caregivers. After the passing, they also follow up with grief and/or spiritual consoling, if desired. Medicare will pay for this.

If the patient prefers to remain and die in Mexico, then he can surely be accommodated there by a different doctor and loving, affordable caregivers. We had a gringo resident, "Chicken John" in Mulege who chose to do just that. He kept a hotel room in town, with caregivers attending him until he died peacefully. He was certainly no "chicken" when it came to bravely facing his impending death. He walked every afternoon and evening (right up to the very end, until he was unable) to Scottie's El Candil Restaurant and sat at the bar taking large quantities of "medication". :saint:

EnsenadaDr - 9-26-2013 at 01:19 PM

Both family and patient in Mexico, and patient in a government run hospital. I am concurring with you 100%.
Quote:
Originally posted by toneart
I cannot speak to Mexican law, but ethically, the doctor is doing a grave disservice to the patient. It is his diagnosis and it is his life! Furthermore, you have stated that he is lucid and competent.

I cannot believe that the family would be prohibited by law. Why don't they disobey the doctor and tell the patient? If it is too delicate or difficult for the family to do this, then they should prompt the patient to confrontationally grill the doctor to directly and fully reveal his condition. I would also convince the patient to go elsewhere for a 2nd opinion/diagnosis.

You have not said whether the patient is a U.S. citizen, or if the family who U2Ud you live in Mexico.

If they have a home in the U.S., they should tell the patient and bring him/her there and seek the options available. If the condition has been diagnosed as terminal, then get him enrolled into Hospice. That will provide the patient with palliative care; to gain the best possible quality of life for the time remaining; to keep him pain free and comfortable, at home.

I am a Hospice Volunteer and can speak with full confidence as to what a wonderful organization it is. They are also very good at counseling the family and even providing respite for the caregivers. After the passing, they also follow up with grief and/or spiritual consoling, if desired. Medicare will pay for this.

If the patient prefers to remain and die in Mexico, then he can surely be accommodated there by a different doctor and loving, affordable caregivers. We had a gringo resident, "Chicken John" in Mulege who chose to do just that. He kept a hotel room in town, with caregivers attending him until he died peacefully. He was certainly no "chicken" when it came to bravely facing his impending death. He walked every afternoon and evening (right up to the very end, until he was unable) to Scottie's El Candil Restaurant and sat at the bar taking large quantities of "medication". :saint:


[Edited on 9-26-2013 by EnsenadaDr]

Justbozo - 9-26-2013 at 01:46 PM

Where is the "Like" button for the toneart posting!

People ask me what would I do if I had a heart attack on the beach in front of my house in Mulege. My reply is enjoy every last second of it!

I have watched too many people close to me pass with cancer...both full treatment and no treatment and Hospice. Believe me, Hospice is by far more peaceful for ALL involved.

Inform the patient, it's THEIR life.

My 2 Centavos.

motoged - 9-26-2013 at 02:55 PM

Quote:
Originally posted by EnsenadaDr
... It's not easy to tell someone they are very sick or have a terminal illness.
Quote:



Sure, it can be difficult for the doctor....but that is not a sufficient reason to withhold such information. Professionals in such positions of trust and responsibility, I believe, have an ethical responsibility to be honest. There is an art to that....and doctors are practitioners of the medical arts. :light:

Cypress - 9-27-2013 at 03:17 AM

My 87 yr. old mother has terminal cancer. The Hospice crew make it possible for us to keep her at home. She's lasted a year, but is slowly slipping away. Without Hospice she would have to be in a nursing home.

DavidE - 9-27-2013 at 12:57 PM

Ensenada Dr. IMHO you are absolutely correct. This particular "doctor" should have a denuncia lodged against him through Sector Salud unless he or she can come up with compelling evidence to the family that full revelation of severity of the affliction of the patient would cause needless harm, physically or mentally. I know that Sector Salud can be rather rude to MD's that promulgate their own rules and code of ethics. The same applies to IMSS. Whewee, an MD that threatens malicious reprisal should be castigated - to the hilt...

DENNIS - 9-27-2013 at 01:21 PM

Jeeezo....this thread is about as "Baja" as catching a dose of clap at Anthony's.

EnsenadaDr - 9-27-2013 at 01:32 PM

Yup that'll do it ya, fur sure!!

Ateo - 9-27-2013 at 01:33 PM

I can't believe a Doctor would not inform their patient of a diagnoses. If I was gonna die I'd want to know so I could say my goodbyes, get stuff in order, and attend a giant orgy. =)

EnsenadaDr - 9-27-2013 at 01:39 PM

Both you and Dennis seem to be thinking along the same lines, but make sure you keep it in Baja, now!!

DavidE - 9-27-2013 at 01:58 PM

Hey Whatchit With The Cracks About The Ladies Bars Willya?

Whatza a little pee'ing without a little screaming, eh?

You guys don't remember the three-tier houses of repute verde in Cd. Constitucion do you?

First one, new pickups, and cars, gravel, well lit

Second one: Older beaters, sand, a light bulb here and there

Third one, swear-to-god, a burro and horses parked outside. No lights and mud.

vgabndo - 9-27-2013 at 02:08 PM

Quote:
Originally posted by DavidE
Hey Whatchit With The Cracks About The Ladies Bars Willya?

Whatza a little pee'ing without a little screaming, eh?

You guys don't remember the three-tier houses of repute verde in Cd. Constitucion do you?

First one, new pickups, and cars, gravel, well lit

Second one: Older beaters, sand, a light bulb here and there

Third one, swear-to-god, a burro and horses parked outside. No lights and mud.


This time, I'm buying every word of this for absolute truth!

Mulegena - 9-27-2013 at 06:39 PM

Ok, I'm coming out here.

It's my family we're talking about here. It's my mother-in-law who is very, very ill. Three weeks ago she was diagnosed with leukemia. She's now in the IMSS Hospital in La Paz.

To clarify: The doctor did not forbid the family from discussing the illness with the patient.

The daughter, not the doctor, has directed the doctor as well as all family members not to discuss the illness with the patient, specifically with respect to prognosis.

The mother does know the name of her illness and knows the treatment. That can't be hidden.

She doesn't know the deeper aspects of the illness or the prognosis. It was the withholding of this information from her by the doctor at the daughter's request that I question and so wrote to Dr. Ensenada to clarify.

Today the whole of the patient's family has gathered together here in La Paz. I'm very focused now on caring for my mother-in-law and cannot spend much time participating in this thread.
I'm about to go in to pull the night-shift in care of her.

Thank you, Dr. Janene, for starting this thread. It's proven to be an interesting topic already. I hope it provides some insight and good discussion here.

Thanks, Nomads, for your prayers and good thoughts for my mother-in-law. I take them with me now.
Mulegena



Quote:
Originally posted by EnsenadaDr
Yes Bob that is the case.
Quote:
Originally posted by durrelllrobert
Quote:
Originally posted by elizabeth
Assuming an adult conscious competent patient, what right does the doctor have to give medical information to anyone other than the patient (unless, of course, the patient has given consent).


Janean wrote:
"..the Mexican Doctor has forbid all family members to tell the patient.."

Sounds like the family members already know but the patient doesn't

DENNIS - 9-27-2013 at 07:37 PM

Quote:
Originally posted by vgabndo
This time, I'm buying every word of this for absolute truth!


True, for sure, that Constitucion was the ho-house district in the seventies.
The workers in Loreto in those days would make bus trips there for weekends.
It was love.





.

[Edited on 9-28-2013 by DENNIS]

Ateo - 9-27-2013 at 07:41 PM

I wish you and your family the very best.
Quote:
Originally posted by Mulegena
Ok, I'm coming out here.

It's my family we're talking about here. It's my mother-in-law who is very, very ill. Three weeks ago she was diagnosed with leukemia. She's now in the IMSS Hospital in La Paz.

To clarify: The doctor did not forbid the family from discussing the illness with the patient.

The daughter, not the doctor, has directed the doctor as well as all family members not to discuss the illness with the patient, specifically with respect to prognosis.

The mother does know the name of her illness and knows the treatment. That can't be hidden.

She doesn't know the deeper aspects of the illness or the prognosis. It was the withholding of this information from her by the doctor at the daughter's request that I question and so wrote to Dr. Ensenada to clarify.

Today the whole of the patient's family has gathered together here in La Paz. I'm very focused now on caring for my mother-in-law and cannot spend much time participating in this thread.
I'm about to go in to pull the night-shift in care of her.

Thank you, Dr. Janene, for starting this thread. It's proven to be an interesting topic already. I hope it provides some insight and good discussion here.

Thanks, Nomads, for your prayers and good thoughts for my mother-in-law. I take them with me now.
Mulegena



Quote:
Originally posted by EnsenadaDr
Yes Bob that is the case.
Quote:
Originally posted by durrelllrobert
Quote:
Originally posted by elizabeth
Assuming an adult conscious competent patient, what right does the doctor have to give medical information to anyone other than the patient (unless, of course, the patient has given consent).


Janean wrote:
"..the Mexican Doctor has forbid all family members to tell the patient.."

Sounds like the family members already know but the patient doesn't

EnsenadaDr - 9-27-2013 at 07:53 PM

Well the daughter can't direct the Doctor not to discuss the illness with the patient, or anyone else for that matter. That is one of his inherent duties as a physician to let the patient be the first to know, and they will decide who to tell and who not to inform. Leukemia is a very grave illness, and the resources for treatment are scarce in Mexico. In some cases, bone marrow transplants are warranted, but I don't know if they have the facilities for that where your suegra is. The doctor should tell the daughter that your mom-in-law has every right to participate in her treatment decision. The herbal remedies are probably harmless, depending on what they are. But I am hoping the Doctor has identified the herb and has allowed it to be given because it is harmless. I did post the patient rights specifically from IMSS to let you know that it is a patient right to be informed of their condition and to know the prognosis, and treatment options, and the patient be able to participate in the decisions regarding those treatment options. To explain possibly the daughter's reasoning at this time I would say she is just overprotective of her mom and doesn't want her to suffer unnecessarily, but she is not being rational and is allowing her emotions to cloud what is the right thing to do, which would be to allow her mother to fully, unequivocally participate in her own care and decision making 100%.
Quote:
Originally posted by Mulegena
Ok, I'm coming out here.

It's my family we're talking about here. It's my mother-in-law who is very, very ill. Three weeks ago she was diagnosed with leukemia. She's now in the IMSS Hospital in La Paz.

To clarify: The doctor did not forbid the family from discussing the illness with the patient.

The daughter, not the doctor, has directed the doctor as well as all family members not to discuss the illness with the patient, specifically with respect to prognosis.

The mother does know the name of her illness and knows the treatment. That can't be hidden.

She doesn't know the deeper aspects of the illness or the prognosis. It was the withholding of this information from her by the doctor at the daughter's request that I question and so wrote to Dr. Ensenada to clarify.

Today the whole of the patient's family has gathered together here in La Paz. I'm very focused now on caring for my mother-in-law and cannot spend much time participating in this thread.
I'm about to go in to pull the night-shift in care of her.

Thank you, Dr. Janene, for starting this thread. It's proven to be an interesting topic already. I hope it provides some insight and good discussion here.

Thanks, Nomads, for your prayers and good thoughts for my mother-in-law. I take them with me now.
Mulegena



Quote:
Originally posted by EnsenadaDr
Yes Bob that is the case.
Quote:
Originally posted by durrelllrobert
Quote:
Originally posted by elizabeth
Assuming an adult conscious competent patient, what right does the doctor have to give medical information to anyone other than the patient (unless, of course, the patient has given consent).


Janean wrote:
"..the Mexican Doctor has forbid all family members to tell the patient.."

Sounds like the family members already know but the patient doesn't

DENNIS - 9-27-2013 at 08:09 PM

Can we all just hold our breath, die, and get this thread over with?


OK...I---2---deep inhale now------3

DENNIS - 9-27-2013 at 08:11 PM

You are now in Andrew's hands. He'll take you to heaven.

toneart - 9-27-2013 at 09:01 PM

Quote:
Originally posted by DENNIS
Can we all just hold our breath, die, and get this thread over with?


OK...I---2---deep inhale now------3


Nope! I'm still breathing and this thread is most serious, especially to the principals involved. These are current, urgent questions that must be resolved.

Mulegenia can be influential in the resolution. I know her. She has her head on straight. I commend her for reaching out with this real dilemma.

I too have Cancer; Lymphoma and Leukemia. So I have gleaned every bit of information, both traditional and alternative. It is not easy to wade through. And then, every well meaning person hits you with their remedy that a friend of a friend, etc....

The onus is on the patient him/herself to do the research and choose the path that resonates best (and responsibly). That is why it is imperative that the patient in this case is completely informed as to what she is up against. She alone has to choose her course of action, or inaction if that is her desire. But she must have all the facts in her arsenal.

Dra. is contributing well to this string, too!

bajabuddha - 9-28-2013 at 03:09 AM

I have been watching didigently throughout this thresd and there's one other avenue that hasn't been addressed. I also have diabetes mellitus type II, hypertension, high choleserol (hereditary), hereditary cardiac and aortal atherosclerosis(w/3 stents), broken back (T-1 compression fracture with failed kyphoplasty), degenerative disc disease, chronic depression, PTSD, bad attitude and a few lesser but annoying inconveniences, including temporary and fleeting sobriety (AA is for quitters).

All seriousness aside, we forget the patient's choice more than just hospice or full chemo-radiation longevital misery. There's a difference between flat quitter's suicide (mostly a f--- U to somebody somewhere) and a terminal patient's right to choose their own time and place of passing in a calm, controlled and dignified exit.
PBS had a wonderful special on FinalExitNework.com, and as far as my future is concerned when the time comes and i'm still able to choose, it's helium for me.

Simple suicide may be the coward's way out, but if you self-delve into the true choices and decisions, it's a brave person to take the reigns of their own life, and death... and ease it all into a doable, finished and prepared parting. For those with terminal situations, beats being a rutabega and cleaned up after for weeks and months until 'Who's God' decides to pull the plug. I'd rather have that choice myself, i DO have that choice anyway, and don't care about society's morals. I'm not F---U'ing to anyone, i'm choosing my DIGNITY to pick my own time, with all legaleses in place.

This so far (i think) hasn't been a part of this thread, but to me, should be. I hope i haven't offended anyone. If so, i deeply appologize. To me birth is the second-greatest miracle (i've been an EMT).... death is the greatest. The first is still 'iffable'... the second is mandatory and set in the Stone of Life. Once again, i'm sorry if this is too sore of a subject, but i feel deeply for it.

Happy trails,
bb

EnsenadaDr - 9-28-2013 at 08:06 AM

Patient assisted suicide is not legal in Mexico at this time. In fact, many of the narcotic medications given to patients in the US such as morphine or valium are not readily available in Mexico to relieve intractable pain and/or anxiety for patients suffering with terminal cancer, or post operative patients dealing with severe post operative pain. There is a special license in Mexico that can be obtained to administer these medications, and I firmly believe that in cases such as these, not administering these medications to relieve the pain adequately of the patient would be cruel and inhumane. Many times in the course of treatment with potent painkillers, in the US, the patient may pass away peacefully. My uncle in New Jersey had intractable pain and was placed on a morphine drip because of terminal cancer. He could never be fully awake because he would be screaming in pain. Thankfully he passed away without suffering because the doctors kept him medicated enough so he didn't suffer. If the pain or anxiety is controlled adequately I don't see a need for suicide.
Quote:
Originally posted by bajabuddha
I have been watching didigently throughout this thresd and there's one other avenue that hasn't been addressed. I also have diabetes mellitus type II, hypertension, high choleserol (hereditary), hereditary cardiac and aortal atherosclerosis(w/3 stents), broken back (T-1 compression fracture with failed kyphoplasty), degenerative disc disease, chronic depression, PTSD, bad attitude and a few lesser but annoying inconveniences, including temporary and fleeting sobriety (AA is for quitters).

All seriousness aside, we forget the patient's choice more than just hospice or full chemo-radiation longevital misery. There's a difference between flat quitter's suicide (mostly a f--- U to somebody somewhere) and a terminal patient's right to choose their own time and place of passing in a calm, controlled and dignified exit.
PBS had a wonderful special on FinalExitNework.com, and as far as my future is concerned when the time comes and i'm still able to choose, it's helium for me.

Simple suicide may be the coward's way out, but if you self-delve into the true choices and decisions, it's a brave person to take the reigns of their own life, and death... and ease it all into a doable, finished and prepared parting. For those with terminal situations, beats being a rutabega and cleaned up after for weeks and months until 'Who's God' decides to pull the plug. I'd rather have that choice myself, i DO have that choice anyway, and don't care about society's morals. I'm not F---U'ing to anyone, i'm choosing my DIGNITY to pick my own time, with all legaleses in place.

This so far (i think) hasn't been a part of this thread, but to me, should be. I hope i haven't offended anyone. If so, i deeply appologize. To me birth is the second-greatest miracle (i've been an EMT).... death is the greatest. The first is still 'iffable'... the second is mandatory and set in the Stone of Life. Once again, i'm sorry if this is too sore of a subject, but i feel deeply for it.

Happy trails,
bb

Mulegena - 9-28-2013 at 08:37 AM

Hi, Everybody,

It's Mulegena. I'm back at my aunt's house after a night guarding over mom-in-law. She rested on and off most of the night. Had some minor complications which she and I and the nurses handled.

What's on my mind this morning is patient advocacy, advanced directives, power of attorney for healthcare. These are things which everyone needs, I feel, and especially having someone who will step up and "go to bat" for the patient. When you're sick, you need someone to stick up for you, speak for you if need be.

The Mexican culture is one in which there is a matrix of broad family ties. Someone will almost always be there for you. As far as having legal documents in place, well that concept probably isn't existent for many. Additionally, the psychological makeup of people tends to be one of quiet stoicism in times of stress. There doesn't appear to be any deep angst or philosophizing on one's circumstance.

Within my family there is little understanding of the science of medicine. There's acceptance of circumstance and trust that doctors will do their best to cure. The influence of the Church runs deep, deeper than the trust in medicine. The belief in God and miracles is forefront in the hearts of the people. To quote a family member, "We feel that medicine helps, but we believe in miracles." I was gobsmacked when I heard this and I think my head spun around 3 times. I've spent most of my adult life in the practice of medicine and study of science; I believe in science and medicine-- miracles are nice when they seem to occur but I'm not holding my breath.

We'll see what these next couple of days bring. I'm going to nap now then go back to the hospital in the afternoon. Thanks for your continued strong thoughts and goodwill.

Directives and POA

bajaguy - 9-28-2013 at 09:04 AM

We have been working with a local attorney to complete our (Mexican) wills, advanced directives, power of attorney for healthcare and a general POA for decisions that need to be made.

All of this goes through a Notary and is recorded at the Municipal offices and in the Notary file at the state capitol in Mexicali.

September (and October) Wills in mexico are 50% off. Will be costing us 900 pesos each.

These are important documents to have if you are full or part timers in Baja.

EnsenadaDr - 9-28-2013 at 09:07 AM

Excellent contribution here, Bajaguy. I have seen cases where none of this is in place and things going totally haywire.
Quote:
Originally posted by bajaguy
We have been working with a local attorney to complete our (Mexican) wills, advanced directives, power of attorney for healthcare and a general POA for decisions that need to be made.

All of this goes through a Notary and is recorded at the Municipal offices and in the Notary file at the state capitol in Mexicali.

September (and October) Wills in mexico are 50% off. Will be costing us 900 pesos each.

These are important documents to have if you are full or part timers in Baja.

EnsenadaDr - 9-28-2013 at 09:13 AM

It's wonderful your mother-in-law has such a caring advocate for her. Unfortunately, the Mexican culture is steeped in the Catholic religion to the point of sometimes ignoring medical fact and advice. All you can do is give your emotional support to your suegra and try to convince the family members to do the right thing by her. Have a good day and get plenty of rest and I hope you don't get too exhausted. Attending to gravely ill family members can sometimes cause the caregivers to get sick themselves.
Quote:
Originally posted by Mulegena
Hi, Everybody,

It's Mulegena. I'm back at my aunt's house after a night guarding over mom-in-law. She rested on and off most of the night. Had some minor complications which she and I and the nurses handled.

What's on my mind this morning is patient advocacy, advanced directives, power of attorney for healthcare. These are things which everyone needs, I feel, and especially having someone who will step up and "go to bat" for the patient. When you're sick, you need someone to stick up for you, speak for you if need be.

The Mexican culture is one in which there is a matrix of broad family ties. Someone will almost always be there for you. As far as having legal documents in place, well that concept probably isn't existent for many. Additionally, the psychological makeup of people tends to be one of quiet stoicism in times of stress. There doesn't appear to be any deep angst or philosophizing on one's circumstance.

Within my family there is little understanding of the science of medicine. There's acceptance of circumstance and trust that doctors will do their best to cure. The influence of the Church runs deep, deeper than the trust in medicine. The belief in God and miracles is forefront in the hearts of the people. To quote a family member, "We feel that medicine helps, but we believe in miracles." I was gobsmacked when I heard this and I think my head spun around 3 times. I've spent most of my adult life in the practice of medicine and study of science; I believe in science and medicine-- miracles are nice when they seem to occur but I'm not holding my breath.

We'll see what these next couple of days bring. I'm going to nap now then go back to the hospital in the afternoon. Thanks for your continued strong thoughts and goodwill.

bajabuddha - 9-28-2013 at 09:29 AM

It's not just the Church they turn to in times of medical need; my old and dear friend that ran the little beach camp i stayed at for many years had an obvious tumor on his neck, and rather than see a doctor he went to the local 'Bruja' or Herbalista for aid. Unfortunately by the time it progressed and he ferried across to Hermosillo, he was obviously in stage 4. Never made it back home. I miss him dearly to this day.

EnsenadaDr - 9-28-2013 at 09:37 AM

You are right about that. When you think about it, the Catholic Church forbids the worship of false Gods or loosely translated, the consultation with any voodoo types or self-proclaimed healers. I know Mulegena was concerned about the herbs the family brought in. I have seen some of the herbs they bring in and most of the time they are harmless, but some can act as a stimulant like Gingko Biloba, and affect the heart. I will never forget an elderly legally blind lady that lived in San Antonio del Mar, and she signed over her home to a local church in Rosarito upon her death. Three weeks later she was dead.
Quote:
Originally posted by bajabuddha
It's not just the Church they turn to in times of medical need; my old and dear friend that ran the little beach camp i stayed at for many years had an obvious tumor on his neck, and rather than see a doctor he went to the local 'Bruja' or Herbalista for aid. Unfortunately by the time it progressed and he ferried across to Hermosillo, he was obviously in stage 4. Never made it back home. I miss him dearly to this day.

DENNIS - 9-28-2013 at 09:48 AM

Quote:
Originally posted by EnsenadaDr
You are right about that. When you think about it, the Catholic Church forbids the worship of false Gods or loosely translated, the consultation with any voodoo types or self-proclaimed healers.


Not entirely so. There are cases in the annals of conversion that note a compromise in beliefs so as to keep the interest of the converts. I believe the Spanish were aware of this judicious tolerance.

bajalinda - 9-28-2013 at 09:56 AM

Very timely topic here - Bajaguy, recently we have also been trying to get info about the Mexican equivalent of what I think is called a Living Will in the States - document which gives POA to someone who can make medical decisions for you if you are not able to do so yourself. Do you (or EnsenadaDr) know if there is a Mexican equivalent for this? and what is the name for it in Spanish? We have been told that medical decisions will be made by the relatives as long as they prove their relationship with vital records. Well, what if there are no relatives nearby (which I imagine is probably a fairly common state of affairs among the ex-pat community) and a time-sensitive decision has to be made?

Mulegena - hoping for the best for your mother-in-law and all your family.

toneart - 9-28-2013 at 10:34 AM

The story is different than when first presented. It is not the doctor, but rather the daughter who has directed all to withhold the complete picture to her mother.

Family dynamics under stress often gets pretty crazy and unpleasant. That is not somewhere that any of us here on the BajaNomad can go, nor should we.

All I can say is Bless You, L.M.! Try not to take the whole burden upon yourself. You can offer input and support. It appears that the daughter is the primary caregiver. It is not easy to stand by and watch. This illness is insidious. It can kill the Caregiver too.

BajaGuy has given good information on Health Directives in Mexico. The patient may have already abdicated her personal responsibility to the daughter. But, if she is still competent, she should have that option to give a legal directive. Time is not on her side. Pain management, and often dementia, can quickly remove that option in the end stages.

And again, the main point of this thread is that she really should have full knowledge of her diagnosis and prognosis. But perhaps that is beyond your sphere of influence, Mulegenia. (?)

To Nomads In The United States, there is a wonderful software program from Nolo Press. It costs $60.00. It is a four part legal document; Will, Healthcare Directive, Durable Power of Attorney your final wishes. It is updated annually and is State Specific. It asks you questions so thoroughly (some that you may not have even thought of), that when you make your decisions you are left with a peaceful, confident feeling. You can update periodically as your circumstance and assets change.

EnsenadaDr - 9-28-2013 at 11:58 AM

Really Dennis, this all sounds quite novel and fascinating! Can you quote the sources please?
Quote:
Originally posted by DENNIS
Quote:
Originally posted by EnsenadaDr
You are right about that. When you think about it, the Catholic Church forbids the worship of false Gods or loosely translated, the consultation with any voodoo types or self-proclaimed healers.


Not entirely so. There are cases in the annals of conversion that note a compromise in beliefs so as to keep the interest of the converts. I believe the Spanish were aware of this judicious tolerance.

EnsenadaDr - 9-28-2013 at 12:01 PM

I found a very good source on this on the San Miguel Allende health info site. I will also post another topic thread on this specifically.

http://smahealthinfo.com/Advanced_Directives.html
Quote:
Originally posted by bajalinda
Very timely topic here - Bajaguy, recently we have also been trying to get info about the Mexican equivalent of what I think is called a Living Will in the States - document which gives POA to someone who can make medical decisions for you if you are not able to do so yourself. Do you (or EnsenadaDr) know if there is a Mexican equivalent for this? and what is the name for it in Spanish? We have been told that medical decisions will be made by the relatives as long as they prove their relationship with vital records. Well, what if there are no relatives nearby (which I imagine is probably a fairly common state of affairs among the ex-pat community) and a time-sensitive decision has to be made?

Mulegena - hoping for the best for your mother-in-law and all your family.

DENNIS - 9-28-2013 at 12:04 PM

Quote:
Originally posted by EnsenadaDr
Really Dennis, this all sounds quite novel and fascinating! Can you quote the sources please



No. It's too hot and I'm gonna go on a knee-crawlin' beer drunk.

DavidE - 9-28-2013 at 12:06 PM

Christ, you stay up on your knees?

What a freekin' weenie !

DENNIS - 9-28-2013 at 12:14 PM

Quote:
Originally posted by DavidE
Christ, you stay up on your knees?

What a freekin' weenie !



Only on my way to the final destination.

luv2fish - 9-28-2013 at 12:22 PM

Quote:
Originally posted by DENNIS
Quote:
Originally posted by DavidE
Christ, you stay up on your knees?

What a freekin' weenie !



Only on my way to the final destination.


Would that destination be the alter ????:saint::saint::saint:

[Edited on 9-28-2013 by luv2fish]

DENNIS - 9-28-2013 at 12:41 PM

Quote:
Originally posted by luv2fish
Would that destination be the alter ????:saint::saint::saint:




Nah......Face down on the piso. :lol:

DavidE - 9-28-2013 at 12:51 PM

Shoot yer just xammin stuff close up and not letting the ground get away.

DENNIS - 9-28-2013 at 12:54 PM

Quote:
Originally posted by DavidE
Shoot yer just xammin stuff close up and not letting the ground get away.



Remember "Watching the ant races?" These kids today don't have a book of these snappy bon mots like we did.

DavidE - 9-28-2013 at 01:12 PM

I remember the shore patrol not falling for me pulling a magnifying glass out of my pocket.