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Old 09-11-2010, 08:14 PM
 
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This thread isn't meant to debate about the institution of hospice, but rather some of thier practices.

My elderly aunt recently passed away, she was 95. Her death was to be expected, but it still hurt. she was active and lucid until almost the end. she had a massive stroke, was in the hospital a few days, then transferred to hospice.

I visited her while there, she seemed comfortable enough, but I don't know if I agreed with some of their policies. First, it wasn't my decision, their adult children made the decisions, and it was in accordance with their medical directives, which they had signed many years ago.

They ceased all treatment, which I had to agree with. She was dying, don't try to keep her alive. But the process included denying food and water. she was semi-comatose, couldn't eat or drink, anyways. If she obtained nourishment, it would have been through a feeding tube and IV's. They said they ceased nourishment because it would interfere with the dying process. At first, I agreed, then thought it through again, and now have some doubts.

Like I said, this wasn't my decision to make. The reason I'm turning it over in my head is because my dh and I recently signed medical directives. We indicated we do wish to be given food and water, and pain management, just no "heroic" measures, if we're on our deathbed. I would still want food and water, I understand dehydration is quite painful, dry mouth, internal organs sticking together, spasms, etc. That's not the way to go. But if the body is trying to shut down, is it interferring with the dying process to artifically introduce food and water?

What about the morality of denying a living creature food and water, regardless of the condition? Many years ago I found a kitten, probably a newborn, who simply couldn't eat, he didn't have teeth. I got him a kitten bottle, he couldn't suck. I painstakingly dropped kitten formula drop by drop into his little mouth, because I felt it was my obilgation to help the living live. He's now a big tom cat, weighs about 15 pounds!

Of course, the kitten had has whole life ahead of him, my aunt was in the dying process. So, should we deny the dying food and water to hasten the process? Did she die, or was she killed, being starved and dehydrated to death? At what point do we forego the right to basic alimentation, regardless of our age or other circumstances?

I'm debating this now because I wonder if dh and I should change our directives. Although I wouldn't want to be kept alive indefinitely being artifically fed and watered, I also don't want to starve and dehydrate to death.

Oh, also, they gave her heavy doses of morphine and ativan, guess to keep her out of it. I don't know if she was in a coma or a drug induced stupor. Somehow the whole thing just didn't set right with me.

So, opinions, please!
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Old 09-11-2010, 09:13 PM
 
Location: San Antonio/Houston/Tricity
41,382 posts, read 59,729,093 times
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You might have to look at the medical directives she signed. There are many options to check. She might opted out feeding other than per oral.
Artificial Hydration and Nutrition -- familydoctor.org

You can change, add or otherwise modify your directive.
You can check it here:
http://www.galenpress.com/extras/extra1.htm
http://www.helpguide.org/elder/advan..._life_care.htm
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Old 09-11-2010, 09:33 PM
 
Location: Tampa
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When I'm ill with something as simple as a bad cold, I have no desire to eat or drink.

Those in advanced/final stages of illness most likely have no desire for food or drink either. When the body starts preparing for death, the hunger and thirst needs shut off.

This was "my" experience with two loved ones in hospice.
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Old 09-11-2010, 10:11 PM
 
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Thanks for the replies, I'm still upset that perhaps she died in pain and discomfort. they talked abut respecting the dying process, which is something we al need to come to terms with eventually.

would I want someone to interfere with nature? if the body s shutting down, if it can no longer take in nourishment, is it right to shove tubes into someone just to circumvent the dying process?

If a person obviously can live if they can just get past some temporary illness or injury, then, of course. Or like the kitten, it was at the begining of its life journey, not the end.

Well, I still grieve for my aunt, I just hope she went in peace. I hope the hospice knew how to best help, that's all I can hope for. Regardless, she's with God now.
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Old 09-11-2010, 10:12 PM
 
9,967 posts, read 16,577,996 times
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Quote:
Originally Posted by elnina View Post
You might have to look at the medical directives she signed. There are many options to check. She might opted out feeding other than per oral.
Artificial Hydration and Nutrition -- familydoctor.org

You can change, add or otherwise modify your directive.
You can check it here:
GALEN PRESS Medical Book Extras- Sample Advance Directives:
Advance Health Care Directives and Living Wills: Making End of Life Choices; Terri Schiavo

Thanks, will look into!
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Old 09-11-2010, 10:56 PM
 
Location: San Antonio/Houston/Tricity
41,382 posts, read 59,729,093 times
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Quote:
Originally Posted by MaryleeII View Post
Thanks for the replies, I'm still upset that perhaps she died in pain and discomfort. they talked abut respecting the dying process, which is something we al need to come to terms with eventually.

would I want someone to interfere with nature? if the body s shutting down, if it can no longer take in nourishment, is it right to shove tubes into someone just to circumvent the dying process?

If a person obviously can live if they can just get past some temporary illness or injury, then, of course. Or like the kitten, it was at the begining of its life journey, not the end.

Well, I still grieve for my aunt, I just hope she went in peace. I hope the hospice knew how to best help, that's all I can hope for. Regardless, she's with God now.

With all due respect: if she was accepted to Hospice program, then she was terminal ( 6 month or less to live). That was obviously not a temporary illness or injury. And it is true, people in active process of dying do not desire food or drink. Forcing it would be cruel and would prolong the process of dying. Would you like to do that to your aunt?
Also you said that she received Morphine and Ativan. Those medications are to keep her painless and comfortable. Therefore I would not say that she was in discomfort and pain.
Grief is the normal and spontaneous outpouring of thoughts, feelings, and behavior in response to a loss, but I hope that knowing that your aunt was kept comfortable and pain-free will provide you with peace and acceptance of her death.

The last days of life are unique for each person. In the final weeks of life many people become very weak; are drowsy, with much sleeping; have decreased appetite and thirst, with an inability or unwillingness to eat any food; probably have difficulty swallowing fluids; and are less able or willing to talk. When further care is no longer going to change the person's condition, all effort is made to keep him or her comfortable. This will include making the decision that there will be "No More Emergencies."
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Old 09-11-2010, 11:12 PM
 
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Quote:
Originally Posted by elnina View Post
With all due respect: if she was accepted to Hospice program, then she was terminal ( 6 month or less to live). That was obviously not a temporary illness or injury. And it is true, people in active process of dying do not desire food or drink. Forcing it would be cruel and would prolong the process of dying. Would you like to do that to your aunt?
Also you said that she received Morphine and Ativan. Those medications are to keep her painless and comfortable. Therefore I would not say that she was in discomfort and pain.
Grief is the normal and spontaneous outpouring of thoughts, feelings, and behavior in response to a loss, but I hope that knowing that your aunt was kept comfortable and pain-free will provide you with peace and acceptance of her death.

The last days of life are unique for each person. In the final weeks of life many people become very weak; are drowsy, with much sleeping; have decreased appetite and thirst, with an inability or unwillingness to eat any food; probably have difficulty swallowing fluids; and are less able or willing to talk. When further care is no longer going to change the person's condition, all effort is made to keep him or her comfortable. This will include making the decision that there will be "No More Emergencies."

I certainly wouldn't want food or water "forced" on her if it made her uncomfortable. I just wish I could be at peace knowing she was comfortable at the end.

It was certainly a more dignified end than being months on end with tubes every which way, I know pain medicine loses its effectiveness in a relatively short time, being in a medical limbo isn't the way I would wish for anyone, either. Also, the bill it runs up for the surviving family is plain cruel as well when there's no real hope. Hospice is really a more dignified way to go, that's what its all about, dignity. we can't cheat death, just soften it as best we can. meanwhile, live each day to the fullest, you only get one chance!
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Old 09-12-2010, 12:13 PM
 
Location: Mostly in my head
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My mother was on hospice care in a nursing home for the last 9 days of her life. I was her POA and executrix. She had not had a bowel movement in over 2 weeks when she died. We found she had food in her mouth from the last meal at the hospital when we tried to see if she would eat. She could not swallow. The nurses swabbed her mouth with a moisure agent (little padded sticks in sterile packing) during the day.

When the body is dying, it shuts down everything but heart, lungs, and brain. Food actually hurts as it will not be digested and passed; it just sits like a lump in the stomach. My mother could not even swallow the water we attempted, it just dribbled out her mouth. She coughed up the ice chips my unpleasantly demanding brother insisted she have - I made him wipe up the drool. He really PO'd me by that demand - he was there les than 15 min, one time. It really helps to talk this out with whoever is your POA and your back-up. You never know when your spouse is not going to be able themselves - dementia creeps in slowly. Frankly, I suggest you each name a child as your POA.

She was on morphine and she slept almost all day except when it got time for another shot. I sat with her about 15-16 hrs/day. Her night companion told me she slept then, also.
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Old 09-12-2010, 05:09 PM
 
9,967 posts, read 16,577,996 times
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Quote:
Originally Posted by SouthernBelleInUtah View Post
My mother was on hospice care in a nursing home for the last 9 days of her life. I was her POA and executrix. She had not had a bowel movement in over 2 weeks when she died. We found she had food in her mouth from the last meal at the hospital when we tried to see if she would eat. She could not swallow. The nurses swabbed her mouth with a moisure agent (little padded sticks in sterile packing) during the day.

When the body is dying, it shuts down everything but heart, lungs, and brain. Food actually hurts as it will not be digested and passed; it just sits like a lump in the stomach. My mother could not even swallow the water we attempted, it just dribbled out her mouth. She coughed up the ice chips my unpleasantly demanding brother insisted she have - I made him wipe up the drool. He really PO'd me by that demand - he was there les than 15 min, one time. It really helps to talk this out with whoever is your POA and your back-up. You never know when your spouse is not going to be able themselves - dementia creeps in slowly. Frankly, I suggest you each name a child as your POA.

She was on morphine and she slept almost all day except when it got time for another shot. I sat with her about 15-16 hrs/day. Her night companion told me she slept then, also.
thank you for sharing the rather unpleasant details of your mother's last days. It makes me feel the best care was given my aunt under the circumstances. I was upset thinking perhaps she suffered, now I am more at peace realizing the dying process was managed with the best possible care.

To have forced food and water down her would have indeed been cruel and served no real purpose, except to satsfy the living that we were doing what we could Indeed, the best thing to do for her was exactly what was done, let the dying process happen.

I now realize we did the best thing with our cat, Mike. he had advanced cancer and couldn't eat. They suggested a feeding tube, but if his body was shutting down that food would have just sat there undigested, causing more complications. I realize a cat and a human are two entirely different situations, but death is death, for all God's creatures.

Thanks again for your input, it does help.
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Old 09-12-2010, 05:32 PM
 
Location: Central NJ
633 posts, read 1,758,317 times
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My mother died today at 3:34
My sisters were basically in charge with what was called humane hospice care. My mother was told she had stage 4 colon cancer after a liver biopsy. She was 81 and did have slight emphysema. It was decided to bring my mother home and not do any follow up test for the colon cancer. Her doctor said to my sister that a colonoscopy would possibly kill her due to anesthesia. I was outraged that no other follow up tests were performed. That was 1.5 months ago and the last 2 weeks of what I feel was torture. My mother had slight dementia and had no concept of what hospice meant.
I wish she had died on the table.
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