“Pain free” does not have to mean coma. My late spouse was kept comfortable and pain free during his last week, yet was able to carry on a conversation a half an hour before he died. In his case it was cancer rather than dementia or advanced old age or a broken hip, but the point is that keeping someone comfortable doesn’t have to mean knocking them unconscious.
That’s true, but when you’re withholding food and water, I think it’s best to knock them out.
Even better. Floating around on a morphine cloud chatting with my loved ones until I fade away sounds pretty good to me.
Yeah, well, I guess I don’t really know. But Mom was in severe pain (she couldn’t sit up, or roll over, or get out of bed by herself), and she refused to eat. All she wanted to do was sleep, so we obliged her.
Okay, but you’re making the perfect the enemy of the good here.
Again - my late spouse, who as I have stated was conscious and competent enough to hold a coherent conversation very near death, had not eaten for close to ten days and hadn’t been drinking either (he did have an IV) and expressed neither hunger nor thirst even when directly asked.
Again - it is quite common for the dying to not feel either hunger or thirst when the end is near. It’s not a matter of denying it, or ignoring it, they just do not feel it. So there is no suffering or pain in not forcing them to be fed or watered. If they are experiencing dry mouth there are ice chips, or they can sip water. If they’re hungry and ask for food it can be brought to them (but it’s not uncommon for them just to nibble a bit then go back to ignoring food).
There was no need to knock out my dying spouse, so he wasn’t medicated to that point. He repeatedly stated that he was not in pain (and when he was he was given more morphine), not hungry, and not thirsty.
Yes, that’s basically how my loved one went out.
Not always; but sometimes it does.
You’re generally not withholding it from somebody who actually wants it.
Unless it’s somebody who’s decided they need to get it over with early for fear of not being able to do so later, [ETA: or somebody who’s dealing with something they can’t bear to keep living with that isn’t going to cause their imminent death, but can find no better way out than refusing food] they’re probably not in distress from hunger and thirst.
I’ve no objection to instituting imperfect measures if they’re the best that can be done, or the best that can for whatever reasons be done at the time. I’m just saying that we should recognize the imperfections, in the hope of being able to eventually reduce them. Absolute perfection’s probably not available in this area.
If that is the case then I have no objections to a “medically induced coma” for purposes of pain relief, even if that may hasten death. What I would object to is making earlier death the primary objective here rather than a side effect of relieving suffering.
Food and water is never ‘withheld’. Dying people mostly don’t want food and water. Respecting their wishes is more important than force feeding them to make other people feel better.
My BIL intends to starve himself to death in the near future. That’s the way his sister killed herself. He has and his family all had Huntington’s. As I understood it, they have a pretty good idea of what the course iss expected to be.
PAS not available in IL.
Do you think that pain only begins when the person dies, though?
For the last three or four years, my mother-in-law has been in a memory care unit, near us. She’s one of the lucky ones – my wife visits her twice a week, makes sure she has clean clothes and is eating regularly. She spends all day blankly staring at the wall or the TV, or playing with a deck of cards. (She used to play solitaire, but she’s gradually lost that, so now she just shuffles and arranges the cards in a pattern that makes sense to her). She still has some pleasures – she likes to read along when my wife reads children’s books to her, or puts together a puzzle, and you don’t want to get between her and her ice cream at dinner time.
But she doesn’t know who my wife or I are. She very occasionally remembers that she has a daughter, but doesn’t know who the woman who visits to read pop-up books with her is. She doesn’t recognize the people in the picture frames in her room, or remember her hometown, or her career as a nurse.
Yes, she’s alive – her heart beats, she breathes, she eats her dinner and her candy. But my wife’s mother is dead. The sweet woman who loved Gene Autry, had a bookshelf full of novels, and always looked forward to returning to her home town for high school or nursing school reunions, the one who scrimped and saved to put my wife through grad school after her husband left; that woman is dead.
My wife has been in sorrow for the past three years, grieving her loss. Can you imagine what a blow it is when your own mother doesn’t recognize you? Which is hard enough, but she has the additional stress of seeing her mother in decline, of worrying what happens when the money runs out and she has to put her mother in some grim Medicare-funded nursing home, of cleaning the feces off her buttocks because she doesn’t realize she’s soiled herself, of wondering if she’s going to fall and hit her head again, of waiting for the inevitable final call. And she really doesn’t need that shit.
Alice’s* death will be devastating for my wife, and I’m not looking forward to it. But at least it will give her some closure, and allow her to progress in the grieving process, 'til she can finally come to acceptance and peace.
I don’t know where I come down on all this. I’m all for medically-assisted suicide, when the patient can consciously choose to end their life. But doing that to people who lack the ability to consent – yes, that’s complicated. But the black-and-white idea that suicide is always a devastating blow to the victim’s family and always a fundamentally selfish act, simply isn’t true.
*Not her real name.
And waiting for all the ones inbetween, starting with “I’ve fallen and hurt myself and the EMT’s had to come pick me up but I can’t decide whether to let them take me to the hospital” and continuing through 'Your mother’s fallen . . . she’s in the hospital . . . (she got back to the care home) . . . she’s fallen again . . . "
I am in no way upset at my mother for not putting me through a few more days, or months, or years of that. I flinched every time the phone rang – for three years. (And no, I didn’t dare turn it off; or not answer if it rang at three in the morning.)
Oregon has a death with dignity option. The person must administer it to him/herself, and must be compos mentis. The person administering the drug cocktail is required to ask pertinent questions of the patient and be satisfied with the answers. I’m sure that in most of those cases, the patient and his family have discussed the option thoroughly and all or most are on board with it.
As for it being “immoral”, what the heck does that even mean? Seems like an arbitrary ethic imposed by religious beliefs. How does it apply if you don’t believe that life is somehow sacrosanct?
And how is self-imposed death any different than hospice care other than just being quicker? When my son was clearly not going to survive the damage he had done to his liver, we made the choice to remove breathing tubes and other hoses connected to him and not to resuscitate. It was either that or watch him waste away in palliative care, which could take years while he was attached to a dialysis machine.
As for euthanasia for dementia patients, which is not at all the same thing as assisted suicide, I don’t agree with that. Dementia is horrifying, and it is painful for the family who has to witness it, but if the patient is not in agony then assisted death is then for the convenience of the family, not a mercy for the patient.
My parents both died in their sleep about a month apart. Both had health problems but were relatively independent and entirely sentient. They had moved into an assisted living facility (meals and housekeeping, but no medical care/assistance provided) three months before they passed.
Neither made it to 80. They married and had kids relatively late, so I was an orphan in my mid-30s. At the time I felt they went too soon, and that I had been shortchanged. But as the years have passed and I see the horrors so many of my friends and acquaintances are going through with their failing parents, I realize how fortunate I was.
No way am I going to impose that on my kids.
But what if the patient is asking for it?
It’s quite possible to have an official dementia diagnosis, and be in a state in which the health care facility is asking your proxy rather than you to make medical decisions for you, but still be able to express that you’re done and you’d like to go now, before it becomes any worse.
– I really wish it had been possible to have these discussions clearly and coherently with my mother and her doctors at the time. I think she’d a lot rather have been able to make her goodbys as an open discussion, get back to her own bed, and take medication at a time of her choosing with me holding her hand. And I wish I’d been able to do that for her. And I wish, and have some hope, that it might be a possible thing for me, before I need it.
Either that, or else I hope to keel over suddenly, out in a field; and have somebody find me before the cats get too hungry, but after it’s way too late for anybody to resuscitate me. That might happen (I’ve done something about the find-me-before-the-cats-starve part).
ETA: I’ll add that it’s not just a matter of physical agony. Some people with dementia – not all – wind up afraid of almost everything, and unable to understand that they’re safe. Some do keep asking for people who can’t come because they’re dead, and are seriously upset that those people don’t show up. Some know they’re somewhere they don’t want to be, and want desperately to get back home. Not everybody’s happy to just keep shuffling the cards around after they’ve forgotten what they signify; though it does take some people that way.
So these desparately ill people are supposed to live in their own personal hell indefinitely, not to spare any “loved one” any pain, but merely to briefly postpone those “loved ones” pain for a few more months or years before they get to experience it anyhow upon the natural death of the sufferer? And they are supposed to suffer this for the benefit of loved ones who they don’t even remember the existence of?
Abject nonsense. There are none so cruel as they who will not see. You are so afraid of feeling the hurt of someone else’s death that you’d consign them to living hell indefinitely? As this is GD I’ll stop here, although I may have driven a bit over the line already.
Works for me, my mom passed after Alzheimers took her mind from her. She was a smiling turnip seated in a wheelchair for her final 3 years.
mrAru is aware that I do not want that to happen with me, and I do more or less have an exit strategy in mind. I do know that the spinal stenosis is going to chop me off at the waist, rendering me more or less with only the top half of my body, so when that happens I plan on having an urostomy to go along with my colostomy - which makes perfect sense - why should I sit around in a wet diaper when I can pee in a bag along with pooping in a bag?
Us kids did similar with our (non-dementia) mum, who was always very musical and half decent pianist, placing a blaster nearby with a mix tape piping in music from her time but mainly from us kids ('60s/'70s) time that she liked just as much. Pretty well her final source of stimulus in her final week zombied out on level ten pain meds after a two-week stay in hospice.
I’ve always had a fear of loss of volition, so this thread has been a good kick in the pants for me to actually get a lawyer and set up a living will. 
How about you allow me, at initial diagnosis to authorize, on specified threshold, ‘no longer know my name, your name, etc’, my heart meds, bp meds, get stopped. Oh, and I get a diet of high sodium, sweets, caffeine, beer, as I desire.
That’s not suicide, that’s a medication refusal, entirely within a patient’s rights possibly. Also, way less trauma for the caregivers, no ‘switch’ to throw, as it were.
And there’s still that randomness that will seem like it’s time.
I’ve never seen this stated better. I have nothing to add.