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Old February 21st, 2012, 01:40 PM   #1
MonkeyBiz
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End of life decisions

Some of you may have picked up that my Grandpa is is poor health. I'll give some background.

He's 93, has Alzheimer, is legally blind in one eye, and damn near in the other. He's very hard of hearing. We finally moved him to a "skilled nursing" home, that said they could care for him. He weekly gets UTI, because of a swollen prostate, not allowing him to void completely resulting in him having to be catheterized twice a day. He only has 4 teeth, and has swallowing issues, that cause him to aspirate liquids and foods. Oh yeah, and he's a diabetic.

Since he's moved to the nursing home, since he's a fall risk, they don't allow him to get up and walk, thus, his legs have began to atrophy.

Here's the kicker.... His heart is strong, and every so often , he has very good moments of lucidity. My Uncles are saying to "just let nature take it's natural course", and to not assist with anything. It's been decided that standing orders are to not assist with Cardiac, respiratory emergencies. Then there is the issue to artificial hydration and nutrition. The family has said that they don't want to remember him with feeding tubes sticking out of him, and honestly, there's no way he would tolerate it, and would rip it out. He does well with IVs, but now there is questions about that.

With his swallowing issue, it is easier to give him antibiotics, pain meds ect via IV, so he doesn't have to swallow. My uncle is starting to lean towards the no IVs, and to let him die.

My argument it is not our place to give or take life. But is our job to make him as comfortable as possible, and when God is ready to take him, he will. In the mean time, allowing him to dehydrate to death, and not be able to receive any medications via IV is in humane, and it's failing at our responsibility to make him comfortable.

We have enlisted Hospice to come into the nursing home, and assist in his care (County Side nursing him in Jackson Michigan is HORRID care) but they don't do IVs.
What is the right way to go here?
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Old February 21st, 2012, 01:47 PM   #2
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Can your grandpa express his wishes when he is having a lucid moment?
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Old February 21st, 2012, 01:48 PM   #3
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The right way to go is whatever you and your family feel is right. We don't know him as well as you, and what you want may not be what he wants, etc.

I do agree that pulling everything and allowing him to die that way is pretty inhumane. However, what do you think your grandpa would want?

If it were me, I'd want to be gone before ever getting to this point.
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Old February 21st, 2012, 02:00 PM   #4
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Can your grandpa express his wishes when he is having a lucid moment?
No he doesn't. My Grandpa was/is a devout christian, and don't believe he would condone what is essentially assisted suicide. There has been the question of "quality of life" but I say, who are we to decide what is an "acceptable" quality of life? When he has his moments of lucidity, he is happy, and glad to see he is surrounded by family. Those times are getting fewer, and farther... Simply because of the progression of all of is illnesses. My opinion is give him IVs keep him hydrated, give him antibiotics, pain meds. ect. The doctors have said that following that line of care, he could last of 4-5 years possibly. With out it, he has weeks... very painful, sad weeks. It would essentially starve, dehydrate, and kill him with pain. I have a big issue with that, but that's what the way the family is leaning.

I don't think that we should allow our passionate opinion to cloud the fact that we believe that when God is ready for us to come home, that he will take us. I agree that 'mechanical intervention' is not what God would want, as that would be intervening with his plan. That's where I get my thought line of it's our responsibility to keep him comfortable until that time. I guess the gray area is where/what is the point of comfort care and mechanical care?

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If it were me, I'd want to be gone before ever getting to this point.
I believe that's what everybody says, but when God doesn't "allow" your body to give out, you don't have much of a choice.
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Old February 21st, 2012, 04:13 PM   #5
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I believe that's what everybody says, but when God doesn't "allow" your body to give out, you don't have much of a choice.
Not trying to be an insensitive prick here, but it is modern medicine keeping him alive not God.

My Grandmother had vascular dementia. Damn near in the exact same spot as your Grandpa is in. In the end she the disease literally made her forget how to swallow. She had fallen out of her wheelchair and broken her arm which wasn't healing. My Dad could have kept her alive with an IV, but at that point she didn't know who anyone was anymore and tube feeding her just would have drawn out her painful end.

Either way you cut it, whether it's 4-5 weeks or 4-5 years, he's still going to die from starvation, dehydration, etc. It will be painful either way. It's just whether you and your family feel it's necessary to let him continue to deteriorate for 4-5 years or let nature take it's course.
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Old February 21st, 2012, 04:21 PM   #6
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Thats a tough choice, but as you already stated keep him comfortable and hydrated. Pain meds are terrible, they make you constipated and mentally out of touch. When he is ready to go I'm sure he will let you know.
I watched my mother in law die of cancer and it was hard but that is what she wanted, to die at home with family. Tha last two days were the worst, pain meds and keeping her hydrated and when her time was up God took her home. As Christians believe like your grandpa that there is more than this life here on earth, an eternity with God. Until then we wait it out until its time to go home.
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Old February 21st, 2012, 04:35 PM   #7
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I don't envy you at all. It was hard enough to be told via telephone conference as I was racing down 75, that "You need to make a decision involving your mother's care, sir...". I cried and cried coming to the realization that my mother needed to no longer be on mechanical life support.

I don't wish to give advice. I don't regret the decisions made with my mom. Painful to recall what I went through with my sister in order to come to a decision, majorly because my sister feared any decision. She left it up to me.

I don;t even know why I posted to this thread, I've nothing to offer except my condolences. Im terribly sorry.
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Old February 21st, 2012, 04:53 PM   #8
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That's a tough call. As only a grand child I would imagine you don't have as much of a voice. We went through a long and drawn out death with all 4 of my grandparents. It was tough.

The best advice I could give you is to not let your family make the Decision on convenience. Not saying they would, or they are, but it can be an issue for some people. "We don't want to have to watch after mom or dad for 4 or 5 years, lets "end their suffering". Like I said, I don't think that's the case here or very common, but it happens.

From the Christian Stand point, I would hope your Grandpa would have realized by now that he is not in control of his life. God is. And while God does have his timing (by using modern medicine) it might not be for purely your Grandpa's life. God uses our Sufferings to make us stronger. He could very well have your Grandpa in the position he is in to make an impact on someone he interacts with on a daily basis. Coherent or not.

If it were me, I'd make sure he was comfortable and wait for nature to take it's course. That's how my parents (and uncles and aunts) handled all of my grandparents.

And just remember, they took care of you when you couldn't talk, you pooped your pants, and you weren't able to coherently talk. Seems only far that the favor be returned. .
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Old February 21st, 2012, 05:25 PM   #9
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Not trying to be an insensitive prick here, but it is modern medicine keeping him alive not God.

My Grandmother had vascular dementia. Damn near in the exact same spot as your Grandpa is in. In the end she the disease literally made her forget how to swallow. She had fallen out of her wheelchair and broken her arm which wasn't healing. My Dad could have kept her alive with an IV, but at that point she didn't know who anyone was anymore and tube feeding her just would have drawn out her painful end.

Either way you cut it, whether it's 4-5 weeks or 4-5 years, he's still going to die from starvation, dehydration, etc. It will be painful either way. It's just whether you and your family feel it's necessary to let him continue to deteriorate for 4-5 years or let nature take it's course.
I get what you're saying, and I agree in some ways, but not in other. I believe to an extend, God is keeping him alive, his heart is beating well, when he's hydrated, he breathes well. His life sustaining stuff is keeping him alive, modern medicine is just making it more comfortable/tolerable... I think.

What my family is trying to disquingish is, where is the line between modern medicine intervention, and letting nature take it's course. If I had been 'left to take natures course' I would have been dead by the time I was 10.

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That's a tough call. As only a grand child I would imagine you don't have as much of a voice. We went through a long and drawn out death with all 4 of my grandparents. It was tough.
Actually, I do, as up until he went to the nursing home, my mom and I, out of our family, have medical knowledge, were the ones that helped with medical care, took to doctors, interpreted what the doctors were telling my Grandma ect. I've been very fortunate that out of the 10 grand children, my opinion has been asked, many times. Both my Grandma (POA) and Uncle (POA) revert to us (my mom and I) when it comes to making medical decisions. We are on the call list, should a medical need arise, we asses, decide, then contact one of the POAs, to make the legal decision.

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The best advice I could give you is to not let your family make the Decision on convenience. Not saying they would, or they are, but it can be an issue for some people. "We don't want to have to watch after mom or dad for 4 or 5 years, lets "end their suffering". Like I said, I don't think that's the case here or very common, but it happens.
This is exactly what I am trying to avoid. It's seeming that 1/2 my family doesn't want to be inconvienced, and would rather just let him go, roughly.

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From the Christian Stand point, I would hope your Grandpa would have realized by now that he is not in control of his life. God is. And while God does have his timing (by using modern medicine) it might not be for purely your Grandpa's life. God uses our Sufferings to make us stronger. He could very well have your Grandpa in the position he is in to make an impact on someone he interacts with on a daily basis. Coherent or not.
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And just remember, they took care of you when you couldn't talk, you pooped your pants, and you weren't able to coherently talk. Seems only far that the favor be returned. .
Thats what I saying!

Last edited by MonkeyBiz; February 21st, 2012 at 05:38 PM.
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Old February 21st, 2012, 05:38 PM   #10
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My father is close to death, not as close as you describe above.

The one thing that we know is he did not want to be resesitated etc, as he expressed these opinions prior to becoming as ill as he is now.

Did your grandpa ever express / discuss his end of life wishes prior to becoming incapable of making these decisions? Most people have these discussions as they get older.

If so follow allong with that as it was discussed.
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Old February 21st, 2012, 05:38 PM   #11
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Tough call and I don't know how to give advice on this. Did he ever assign anyone with a living will or other document? Otherwise, it becomes a family decision.

What do the doctors recommend?
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Old February 21st, 2012, 05:41 PM   #12
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My father is close to death, not as close as you describe above.

The one thing that we know is he did not want to be resesitated etc, as he expressed these opinions prior to becoming as ill as he is now.

Did your grandpa ever express / discuss his end of life wishes prior to becoming incapable of making these decisions? Most people have these discussions as they get older.

If so follow allong with that as it was discussed.
He did.. kinda. Both my Grandma and Grandpa wanted the same level of care. Nobody explained options, and scenarios to them, thus, the advanced directives have changed... 4 times in the past 8 weeks, It's getting frustrating. I encourage you to indepth talk to your dad, now.. figure this stuff out. Also, check out my thread in the pub about a "go bag". Good Luck to you.
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Old February 21st, 2012, 05:54 PM   #13
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Tough call and I don't know how to give advice on this. Did he ever assign anyone with a living will or other document? Otherwise, it becomes a family decision.

What do the doctors recommend?
There is... But it's messy... My Grandma was in denial that he had Alzheimer's, and finally last year she agreed to make an advanced directive, when he was semi-able to make decisions/understand things. This was done without anybody there who had medical knowledge, and was able explain the scope of the choices that were made. So essentially it is in essence a family decision now, and we are trying to find what is the "right" way to handle this humanly, morally ect. With that, my self and my mom are turned to to interpret/explain the medical jargon as presented, and to assist with a weighted decision. It sucks, bad.
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