Criminal to let an older person die?

In My Humble Opinion
1

This is loosely based on my extended family where the parties involved died decades ago.
Man and wife are roughly 63. He’s a heavy drinker and smoker in declining health. He eventually spends most of his time in bed. Not entirely bed-ridden, but clearly degrading. One afternoon, he just expires. Cause of death is likely related to his heavy drinking and smoking.

The wife had been taking care of him as best she could, but does not schedule dr.s appointments or take him to medical care. Is she likely to run afoul of the law and face prosecution? THe authorities will know that he had been in declining health, but they won’t know that he has adamantly refused to consent to medical care. They also don’t know that he was an abusive husband and wife beater, and that she is more likely relieved. She did not accelerate his death, but she didn’t force him to get medical treatment (she couldn’t physically move him anyway) or call emergency services to take him to the hospital.

This happened in Michigan in 1990, and they were a shade above average in financial security if that matters (he was an engineer, but hadn’t worked in a while due to his health…or being fired for being drunk…not really sure)

So, what are the opinions? Would she be technically on the hook for some elder/dependent abuse?

2

While I’m not aware of the particular legal statutes in MI, this sort of situation happens a lot in my experience. There’s no duty to MAKE someone seek medical care if they’re refusing it and deemed competent. Unless there’s more to it than you describe, I do not anticipate any legal fallout from the situation.

3

Not totally the same, but… My mother was totally anti-doctor/medicine/hospitals her whole life, or at least the part of it I was old enough to witness. She was actually reasonably healthy til she reached her eighties, never having anything worse that the usual colds/flu/minor food poisoning type incidents except for fairly bad arthritis in her knees. She bragged the only time she’d taken drug stronger than an aspirin was during childbirths.

Then she developed Alzheimers, which progressed fairly rapidly. She became unable to live alone safely so spent stretches with various of her children. Then she had a stroke and simply had to be taken to the hospital. (My husband and I happened to be her carekeepers at that time.) There were lots of tests and consultations. The doctors were recommending various rehabilitation facilities and ‘permanent’ care facilities, also various surgeries including knee replacements! For a woman who would never understand why she would be being put through this pain and discomfort, because she’d forget the answer in five minutes or less no matter how often you told her things.

We (her children as a group) were in a quandary over what was best to do. Everyone agreed she would have hated having to undergo medical procedures, but some thought ‘if it’s the best we can do for her’ we should, and others wanted just to basically shift her to a long-term facility to let her exist as best she could with good routine care of the fed/bathed/kept from suffering nature.

Then she had another stroked while still in the hospital. Worse than the first. We children and her chief doctor there (? there were a LOT of doctors passing in and out, never really sorted them out) had a meeting. She suggested we could put her on a ventilator and possibly install some feeding thingy to prolong her life. But, it wasn’t like she really expected my mother to recover to any meaningful extent. She’d never be aware again, she’d just be dying more slowly than otherwise.

I asked if her dying would be worse/more painful if they didn’t do the ventilator thing than if they did and she died some days/weeks later, and the doctor said no, they could give her whatever drugs she needed to keep her painfree either way.

And we all talked for a few minutes, and even the brother who had wanted ‘to do everything possible’ changed his mind. The doctor made no effort to persuade us otherwise. Jn fact, though she said nothing, I really think she agreed it was the best way to proceed. That is, basically do nothing.

Mom died peacefully about eight hours later while a couple of us were sitting there with her. We weren’t even aware what moment it happened. She been breathing slowly and shallow over that time, and then it turned out one of those breaths had been the last.

Anyway, the point is, nobody argued that NOT doing every possible thing to prolong her life was a crime or morally wrong or anything. There certainly were no legal aftermaths of our decision to let her die ‘naturally’ even though she was absolutely not competent to make the decision herself.

4

Perhaps morally wrong but not criminal. You can’t depend on someone caring more about you than yourself. IMHO he gave up on life, a sort of slow suicide.

My dad lasted probably ten years longer than he would have without my moms support, but she did it freely and he worked with her on doing the right things.

5

A good friend of my wife’s in her early 70s had severe heart disease and life had become intolerable since she was essentially bed ridden. She had a conference with her son and husband and announced that she would stop eating. They understood and did nothing to stop her. She died peacefully about two weeks later. I am quite certain there were no legal issues.

6

How would you even do so? If somebody’s competent, they’re entitled to refuse medical care.

I don’t see how it’s even morally wrong. If he wanted to go to the doctor and she wouldn’t help arrange it, that would be wrong. If he could plausibly be talked into going to the doctor and she didn’t try, or he didn’t seem to understand he was in danger and she did understand it and didn’t try to tell him, that would be wrong. If he was just adamant that he wasn’t going to the doctor, it’s not wrong to give up and quit bugging him about it.

7

Court orders. physical restraints. Physical force. It is NOT pretty, and ethically it’s quite dicey.

I’ve been involved in waaaay too many such cases, since my patients are all convicted felons who are imprisoned and thus wards of the state. So as such they have somewhat reduced autonomy when it comes to decision-making.

Mainly they’re still allowed to refuse recommended treatment, decline heroic measures, enter the hospice programs if they’re qualified patients (by standard hospice rules, NOT prison rules), etc. We don’t force them to dialyze, take insulin or other life-saving treatments, as long as they’re properly informed of the consequences.

BUT: they can’t be allowed to commit suicide by starving themselves to death or other such means, while wards of the state. That can result in court orders to tube feed, hydrate, etc.

We do try MANY other approaches first, before resorting to that. And I’m proud to say that during my tenure as a medical director for the prison system, the system as a whole sought out a LOT fewer such orders because I and others pushed to try more reasonable approaches to obtain patient consent. And actual requests for court orders for forced treatments were reserved for when there was clear and direct evidence of a high risk of imminent death. Then it’s up to the judicial system to decide if the State has an overriding interest. If they say the State does not have such an interest, I’m ok with that. And I often disagreed in cases where the court ruled that the State DID have overriding interest.

One guy was dying due to refusing dialysis. He didn’t want to die, he was just demanding a different dialysis time, and to only be cared for by one particular dialysis nurse. He thought refusing dialysis unless his terms were met would get him what he wanted. But we don’t operate that way. Instead of seeking a court order though, we got him on the phone to his mom.

It was amusing to hear his side of the conversation (he consented for me to be there so I could answer their questions). “Yes, mama. No, mama. I’m sorry, mama. I will start my treatment right away, mama!”

BTW, nothing I’ve shared here is a HIPAA violation. Yes, I’m sure.

8

True. But first you have to get the court order, and if the person really is competent or even borderline so, you might well not get it. At least, I certainly hope not; because, as you say, ethically that’s dicey in itself.

9

It is relatively easy to get a court order allowing us to evaluate an inmate who’s refusing evaluation, IF we have reason to believe there could be imminent threat to life based on patient status. Say a guy’s falling over, twitching, losing control of bowel and bladder, and we don’t know why. AND he’s refusing evaluation.

The odds that it could be something likely to cause imminent severe harm are high enough that, for a ward of the state, a judge will readily order evaluation including checking vital signs, doing bloodwork and other basic low risk testing. However, we’d then have to prove we found credible evidence of imminent threat before we could get an order to actually treat the patient.

10

Might be easier to get one for somebody who’s in custody than for most people to get one for a family member, though. There’s already existing authorization to make inmates go places they don’t want to go.

I haven’t actually tried to get a court order for a family member, though, and if I know anybody who has they haven’t told me about it.

11

Oh, it’s FAR easier. As I said, my patients are wards of the state. In my 16 years of private practice, I was not involved in an such actions. In my 20 years working for the state, I have been involved in over a dozen such.

12

I think that a lot of people would argue that letting her go without extreme measures is probably the more morally right thing to do.

13

Maybe. Several years ago, there was a big outcry when an 88-year-old woman dropped dead and the nurse with her didn’t do CPR. The woman was a resident of a nursing home, which had a ‘no CPR’ policy, the family was fine with this policy, but some chunk of the public was outraged. I never understood why, but acceptance of death is clearly not as straightforward as you might think.

14

There’s an occasional row over here about “Do not attempt resuscitation”(DNAR) notes in people’s records. These are supposed to be fully discussed with everyone concerned before being entered, but occasionally there are disputes, or someone objects to the whole principle - until it’s explained (yet again) that CPR might be so vigorous as to break ribs, and would you really expect that to be done to bring grandma back to a few more months of pain and infirmity?

15

Or, rather more likely for anyone who’s got a DNR, a few days.