Making a life and death decision tomorrow

In My Humble Opinion
1

My sister and I are probably going to arrange my aunt’s death tomorrow.

My 70-something aunt has had several heart attacks, including a major one two weeks ago. Her kidneys have failed entirely. She cannot breathe on her own without a respirator. When pressed, her docor said, barring a miracle, she will not regain enough strength to survive unattached to her life support gear.

Her best friend called my sister today. She says my aunt is awake, alert, miserable and desperate. She thinks my aunt wants the machines turned off. But she won’t ask her directly, because she feels it should be a family decision.

My aunt’s husband Joe is 83, and not too together any more. The doctor also will not ask my aunt directly whether she wants to be removed from life support, saying that it’s a matter for the family to decide, but spoke to Joe, “indirectly” suggesting it was time to cease the life support. My uncle say he just couldn’t make a decision like that, the doctor should talk to my sister Kathy. So now Kathy has to ask the hard questions of my aunt, assuming my aunt is still responsive when we get there tomorrow.

My sister wants me to go along, so of course I will. “You can be objective and logical”, she says. How she decided this I have no idea.

If my aunt is able to communicate, we will press the medical staff to obey her wishes. If she is not?..

I really hope I will not have to contribute anything besides a stable presence tomorrow. Because for the life of me I can’t imagine any other objective, logical choice but to turn off the machines. I also do NOT want to make a call like this.

I’m not sure what opinions to seek out here, but I can’t see this as mundane or pointless either. I’ve had a lot of BIG ups and downs in the past year, and I think that’s a major reason why I started posting on the SDMB – I feel the need of external reality checks.

Any ideas you can post by 6 AM Central time tomorrow morning (the last time I’ll be able to check before driving up to Marshfield) on how to handle the next couple of days will be appreciated.

2

  1. If you make or agree to a decision, let your conscience be your guide. Better to excuse yourself from the decision than to agree because of pressure.

  2. If your aunt can’t make the choice, what choice to you think she would make? What quality of life do you think she would want?

It’s a tough spot to be in. We’ll be thinking of you.

Whistlepig
(The OP raises good questions to ask/share with your loved ones. Both of my grandmothers lived longer than they wanted to. This led to discussion between my mother and I about how we would want this type of choice handled for us. Knowing each others postion will make decisions easier if the need to decide ever comes.)

3

I’m sorry you’re having to deal with this, yojimboguy. It’s not easy.
My sister and I had to tell the medicos to take our mother off the machines. We knew she would have wanted this, due to a Living Will, as well as discussions over the years. Still, it wasn’t pleasant. My sis and I were never as close as some siblings are, but since we had to do that together, we’ve developed a much closer relationship.
Making the actual decision shouldn’t be that hard. There is usually only one thing to do that makes any sense, but it’s still not pleasant.

Best wishes.

4

Tough one, guy; sorry to hear you have to deal with it.

My thoughts, worth every penny you pay for 'em:

The hope would be that your aunt is conscious and can provide her input as to her wishes. I don’t know her, or how she feels, but are you prepared to deal with both a.) her wanting life support terminated, or b.) her wanting to keep hanging on? If she’s not able to communicate, you and your sister will have to decide. I suspect it might be an investment in your own feelings in the future to make a point, if it’s possible, to consult Joe - not that he’ll make the call, but I think you’ll feel better you call him into the huddle.

Good luck with it, pal.

5

{sad face}

Hang in there…

6

Damn, yojimboguy, I wish you luck with this.

I spoke with a doctor once who told me about when she was younger, and a favorite uncle had been in some horrible accident and was basically just waiting to die. He was on machines, tube-fed, and after he had (when he still had the strength for it) tried to pull out the machines, IVs, etc., he was strapped down to his bed. (This was before living wills and so on.) She talked about how horrible it was to watch him linger, neither of them able to do anything.

If you know anything about what her wishes might be, try to help be sure they’re carried out. Otherwise, just try to help your family in whatever way you can.

7

Damn, man, I am sorry you are in this position.

If you really feel that you cannot make a choice tell your family. Let them know that you do not feel able to make a desicion like this. Do not feel bad about this, most people would feel the same way you do. It is a terrible place to be.

Also if you do make a choice, as someone else said, what would her quality of life be if she was kept on life support? Personally, if she was going to stay attached machines untill she died, I would probably let her go sooner with less pain. I am not advocating any choice, just telling you what my personal choice would be.

[hijack]
Everyone should talk to their families about this issue. I spoke to my parents and outlined what I thought should happen if there was a situation where I ended up on life support with little to no chance of recovery. I now know my parents wishes and they know mine. If the situation ever comes up the choice will be easier to make because we all understand each others wishes. It will still be painful but somewhat easier. [/hijack]

yojimboguy,

My thoughts are with you. Whatever you choose you will be doing the right thing according to your heart.

Take care and I hope things get better for you,

Slee

8

Just wanted to add a postscript to my previous message, that this woman was sure that her uncle had tried to disconnect himself from life support, that it was intentionally done on his part with what reasoning that he had left, rather than some accidental or unknowing action on his part.

Seconding sleestak and anyone else who recommended talking it over with your family. Learn more about what options are available, and then let them know what lengths you want doctors to go to before they stop working on you.

9

I can sympathize your situation. Having been there myself twice, with two brothers on life support (not at the same time, twelve weeks apart. One we removed support, the other recovered.), it is extremely uncomfortable.

If your aunt is able to communicate, you need to ask a nurse if there is some sort of liasson, a social worker, who can ask your aunt what her wishes are. Even if she is on a vent or a trach, she will be able to get her thoughts out, either writing or a chart they use at the hospital.

If your aunt is able to communicate * it is her decision of what she wants to do with her life * Then your job as family is to support her though the days ( weeks/months) that are to come. The hard part is off of the family for the tough call to make and the hard part begins of waiting. ( It’s like time stops in the hospital.)

If she is unable to communicate then someone needs to step up to the plate and make an informed decisions. Doctors are there to give an unbiased medical opinion. They think that every life should be saved and do their best. They are also controlled by the fear of being sued for not doing enough medically.

( When my brother -#3 - was in near dead condition, lungs collasped, on a vent, and mentally checked out, the doctors kept saying that because he was only 44 and the fact that he has a record of pulling through these situations, that he could pull through again. Not with emphysema and MD also fighting him Thank God he wrote a living will. It took every thing off my mom. I - or any other of my family present - had no problems with the decision, but when you are a mom it is very very different. Brother #3 passed within 45 minutes. Very peaceful. I did not want to be there for it, but I am very very glad I was.)

I am so sorry about your aunt’s condition and she is very lucky to have you and your sister there to help her out.

Peace.

10

It seems gutless to me that the doctor would not discuss with her what her wishes are. Since (from your description) she’s not mentally impaired, this should be her decision to make. You and your sister are doiong the right thing in asking her.

StG

11

Yojimboguy, I’m so sorry to hear about your situation. Best wishes, and kudos for being strong and being there. Your support will be wonderful for your family.

Here’s another opinion saying that it might be better to remove her, if your aunt is unable to tell you herself. I was little, but my great-grandmother died at 84 in the mid-80’s. She had diabetes and had had her foot amputated due to the disease, and was in poor health and very frail. At the nursing home, she eventually stopped eating - it was her way of telling her daughter (my grandmother) that it was time to go. Sadly, my grandmother didn’t listen, and Grandma Lamb was given an IV. She died two or three months later, as I recall, but I really believe it would’ve been better to let her go when she wanted. Sometimes sooner really is better.

Best wishes for you and yours.

Snicks

12

yojimboguy, I can’t do much but echo what other posters have said – if your aunt can communicate, I agree that it would be best to ask her. It’s painful for all involved to be sure (my parents went through something similar with my paternal grandmother) but ultimately it should be her decision to make if she can. Best wishes to you and your family – you’ll be in my thoughts.

13

Thank you all for your kind thoughts. My aunt died today a little after noon, about 20 hours after being removed from life support. We had her transferred to the “palliative care” section of the hospital, basically an in-house hospice. I was in the room with 5 other famly members when she died. I’ve never actually sat in a room and watched someone die before.

There was one particularly troubling aspect of her death for me, and I invite your comments in this thread about the ethics of removing life support.

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I am sorry for your loss.