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I agree on your last part. My dad went into the hospital for what should have ended his life. He has a DNR, but the doctors treated him instead of just giving him comfort meds. The patient advocate got to us too late, but we're smarter now. I love my Dad and know him well enough to know how he's living now is not what he or I would want. When the quality of life degrades, there should be a way to pass on with dignity and surrounded by loved ones, not leaning up next to a tree with a gun and all alone.
My only consolation when visiting my dad is that he does smile as do most of the people there if you interact with them. What his life is like for him, I'll never know.
Ugh, so sorry, again.
I gotta tell you though, I know I'm probably by nature an "outlier", but I wouldn't want my children to be around me if I chose to commit suicide. I truly would not want to share that moment with them. Heck, I'm not sure I'd want them at my bedside if/when I die naturally.
Yes, once they are not aware it would seem much more than "assistance" if they are not cognizant and verbal. Just wondering, does your dad have a DNR? Just in case anything "happens" to him, you wouldn't want the paramedics to undo what he has done. I am so sorry that you even have to think about this stuff.
He does not have an advance directive, but he has a health care agent. You're correct, if some idiot calls the paramedics and we children are not around to intervene, they will resuscitate. Thanks for mentioning this - I'll try to come up with a plan that would resolve the issue. Perhaps my sister can mention it to his doctor and obtain the proper document when she takes my Dad for a consultation this week. The document would be placed on his refrigerator, just as we did with my mother.
Unfortunately, DNR only covers cardiac/resp. arrest, and few people are fortunate enough to end this way. "Assisted suicide" can simply mean getting a lethal prescription for something like barbiturates, and should the person decide it's time, they take the pills and are gone in peace, without guns and hiding and hanging and all the other nightmarish scenes that people undertake. If someone was not cogent enough to go through the steps of legally assisted suicide (as there is in Washington State, Oregon, and Vermont) then they could not be assisted and would have to rely on DNR and advance directives.
Dementia itself will eventually kill a person but it takes many years and the decompensation is increasingly unpleasant. For that matter, legally assisted suicide at this point, I think, requires a six-month death diagnosis or thereabouts, which dementia wouldn't cover. I am not sure what people do with terrible neurological diagnoses, like ALS or dementia or something that doesn't kill you in about six months. I suspect there might be quite an underground traffic in barbiturates, and as one poster pointed out, you can get these over the counter in Mexico.
There's no good answer but people should have more options than the lonely, violent and grisly options that many do take.
You are very mistaken. The general rule is the attending physician, i.e. the patient's personal physician, will certify the cause of death. Attending physicians are loathe to attribute suicide as the cause of death unless there is no other reasonable explanation. If there is no other reasonable explanation, they are required to notify the medical examiner or coroner. Think about this:
If I weren't present at my mother's death, I would have no way of knowing she had not committed suicide. She was sick with cancer, therefore there was no need for an autopsy. Her death was automatically attributed to the cancer. The same thing occurred with my friend's mother and she didn't even have cancer or heart disease. She was diabetic, hypertensive and old. Her primary doc certified her death was caused by "heart failure" or some other generic cause. NO autopsy.
Same thing with my former best friend. She had cancer and died at home at the ripe old age of 40. Did her husband help her along? Who knows...there was NO autopsy.
Another friend who's husband had ALS. Although he eventually died while in the hospital of respiratory failure (sped up a little by respiratory depressing doses of morphine) his wife was previously told by his physician to be careful and not exceed x number of pills from a particular prescription because any more than that, could lead to his death. And NO, there would have been NO autopsy, even if he had died at home.
It is not routine to autopsy the bodies of seniors who often have chronic illnesses and die at home. In my state, only suspicious deaths (or those requested by family) undergo autopsy. Most (but not all) doctors will sign the death certificate with their best guess as to the cause of death if the patient's medical history provides a foundation to do so. If the deceased does not have an attending physician, then it is more likely an autopsy will be performed to establish the cause of death. However, unlike younger folks, very few seniors do not have physicians.
IOW, the data regarding suicides among the elderly is likely grossly under reported. Check out the CDC website to confirm the procedure for completing a death certificate and you will understand why this is.
Lenora, you are entirely correct on this. Except it's not just suicides among the elderly that is grossly under reported. It's all ages, and particularly when it occurs with children, teens and young adults.
Not to scold you, Lenora, but this entire thread is a lesson in getting the paperwork done BEFORE it's needed. EVERYONE needs a will unless they have zero assets. EVERYONE needs a power of attorney and a living will (even if they want every life saving attempt made - it's not just for shutting everything down). If your father has substantial assets, he should have had a Living Trust.
The assumption that the kids will just inherit everything equally is often a fantasy. You have no idea how many siblings end up enemies because of this kind of stuff. And it's not just about money. I know one family who haven't spoken decades because they disagreed on the type of funeral service dad would have wanted! Others that remain permanently bitter about who got mom's favorite earrings or dad's fishing gear.
The kindest thing you can do for your family is to do the planning and the paperwork, then sit down and tell them what you've decided. Don't allow for end of life, or after death surprises. That's a cruel joke.
Last edited by Jkgourmet; 04-08-2014 at 08:52 AM..
Once a person has degraded enough cognitively , it is true, they would not likely to consider suicide anymore.
However, this is most likely precisely the state that the person wanted to avoid ever reaching.
Solution? I certainly don't have one.
There is a very good novel, "Still Alice" about a woman who planned to commit suicide once she felt the time had come.
It is, I believe the only or one of the very few recommended by the Alzheimer's Assn
Once a person has degraded enough cognitively , it is true, they would not likely to consider suicide anymore.
However, this is most likely precisely the state that the person wanted to avoid ever reaching.
Solution? I certainly don't have one.
There is a very good novel, "Still Alice" about a woman who planned to commit suicide once she felt the time had come.
It is, I believe the only or one of the very few recommended by the Alzheimer's Assn
I read "Still Alice" a few years ago on the recommendation of a friend/psychologist/attorney. He thought it would make me realize that there was no way I had a mild cognitive impairment. Instead, it scared the bejesus out of me.
I agree that it is an excellent read and I still have it on my Kindle, readily available should I feel the need to engage in a long crying jag.
Lenora, you are entirely correct on this. Except it's not just suicides among the elderly that is grossly under reported. It's all ages, and particularly when it occurs with children, teens and young adults.
Not to scold you, Lenora, but this entire thread is a lesson in getting the paperwork done BEFORE it's needed. EVERYONE needs a will unless they have zero assets. EVERYONE needs a power of attorney and a living will (even if they want every life saving attempt made - it's not just for shutting everything down). If your father has substantial assets, he should have had a Living Trust.
The assumption that the kids will just inherit everything equally is often a fantasy. You have no idea how many siblings end up enemies because of this kind of stuff. And it's not just about money. I know one family who haven't spoken decades because they disagreed on the type of funeral service dad would have wanted! Others that remain permanently bitter about who got mom's favorite earrings or dad's fishing gear.
The kindest thing you can do for your family is to do the planning and the paperwork, then sit down and tell them what you've decided. Don't allow for end of life, or after death surprises. That's a cruel joke.
No need to worry about scolding me. My sister and I did everything within our power to convince our father he needed to take care of things. As I noted in another post, she's still ticked off that he put us in this position. That said, I disagree about a Living Trust. I find they are overused and totally unnecessary in my father's case. BTW, my sister is a joint owner on one account. A while back we figured if she continued to deposit his investment dividends, pensions (2), and Social Security check into that particular account, there would be enough accessible funds to cover "emergency" expenses for at least six months (including in-home care).
The kids WILL inherit everything equally because if I am appointed the personal representative of his estate (most likely since I am an attorney), everything will be properly executed. Ditto for the sister who has been managing his daily expenses and health care needs for over a year. My experience is that there is always one child who is a pain in butt. That's almost a given.
We are really in a much better position than most. The ONLY risk is that someone, whether it is a family member, neighbor or stranger, will take advantage of his innate generosity and newly acquired vulnerability before we can assume full control of his assets. Don't forget, HE'S not worried about preserving his assets for long term care because he has no intention living like that. "Sorry, Dad, but we need to preserve your assets for Plan B - just in case." All potential heirs can go pound sand.
Oh, wait! I just reread your post - I don't agree that everyone needs a will. I don't have one and I don't intend to get one. Well, at least for now.
When my father was put in a nursing home by my sibling, against his wishes to die at home, he chose to starve himself to death. This method actually has a name which I've forgotten now, maybe its VSED. He was very old, and slower mentally, but did not have AD or anything like that. When he was put in there a DNR and no tube feeding or ventilator assistance was specified. The nursing home obviously knew what he was doing and gave him some support to make it less difficult. It did not seem to be a hard death and allowed a couple of weeks for all of us to say our good-byes. The nursing home wrote on his death certificate that he had died of cancer of long duration. He did not have cancer.
Refusing food or fluids is one way and it's reportedly not painful. For example, people who go on extended fasts reported euphoria and well-being after a few days of actual hunger. Of course, it's critical that instructions be given not to insert a feeding tube or IV- another reason people do *not* want to get caught in the medical/mental health systems. It's a plan that I have considered for myself if I reached that decision point. It beats dashing to Mexico for Nembutal or something. Again, I do think if a typical terminal diagnosis is given, many physicians might make the necessary prescriptions, but in the case of neurological diagnoses, all bets are off.
Lenora,
I know from experience how hard it is to watch parents deteriorate. You are not alone in this. Here is my story which may or may not help you. (sorry it's so long)
My parents were living in a 55+ community when my dad's memory started going. His doctor told him it was a short-term memory problem... never said Alzheimers, which I think was probably good at the time because it would have freaked him out. At the same time, my mother's eyesight was deteriorating due to macular degeneration. Now visualize this: he was still driving, his driving skills were ok but he couldn't remember how to get places. My mother, thanks to her good memory but hampered by poor vision, would give him turn by turn directions whenever they went out.
When I realized what was going on, I researched Assisted Living facilities and was able to convince them to move to one near me. It took a lot of talking to make them understand that Assisted Living was not the same as a nursing home. So they moved and all was fine for awhile. My dad continued to slowly deteriorate but still read the newspaper every day... wasn't sure how much he understood until one day he showed my mother an article about Viagra. He wanted her to ask the doctor for it on their next visit. She was too embarrassed; told him to write himself a note so he could remember to ask the doctor himself.
Time went on and eventually the Alz started affecting physical systems. We moved him to the Alz wing of the facility. He was aware enough that he didn't like it but also understood that my mother couldn't help him anymore. My mother was able to spend most of each day with him. Fast forward: he couldn't stand up anymore, started having heart problems and his lower digestive tract stopped working correctly. They called an ambulance and I met him at the hospital; he was unconscious. I knew it was time to let go and I told the doctors to just make him comfortable. They put 2 fentanyl patches on him (doctors know what to do) and sent him back to assisted living. He passed shortly after and my mom came to live with me. I think he still knew my mother and me til the end.
Next came the hard part. Over time my mother had several strokes, rehab, walker, wheelchair. She started talking about her cousin Lil who was out with a friend, came home, and asked the friend to take her to the hospital. She died a few days later. My mom wanted to go like that. Then she started saying she was ready to die. She was coherent and not depressed; I understood her enough to know this was a conscious decision on her part. Her next idea was to stop eating and drinking, which would allow her to die in a week or so. As much as it hurt me, I knew I couldn't fight her on this and had to let her die with dignity her own way. But I did tell her she couldn't do it in my house because I just couldn't watch her do this to herself. She agreed to go to a hospice facility and made me promise to not let them give her IVs or any life saving measures. So she had her way; she was 82.
In the end, you do what you think is best to keep them safe. You try to convince them to get live-in help, or move in with you, or go to assisted living. But they are adults who get to make their own decisions. And when it is time for them to go, you just have to accept it and let them, no matter how hard it is on you. Then you cry.
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Letting Go
