Wednesday, July 03, 2013

Which Life Prolonging Intervention Would You Choose As The End Nears?

We're all dying.
We start that process when we're born.
Some of us are closer to the due date than others.
Some of us don't realize how close we are, because the statistics suggest we shouldn't die soon.
But things happen.
Others wait, impatiently, to die.
The increasing number of aches and pains and bodily failures that come with aging, are, I think, a way to make dying less disturbing.  Eventually, dying seems, if not a better option than living, then at least a reasonable one.
I'm thinking about this a lot because at 91 my mom would seem closer to her due date than most.
And while she worked, by choice, until she was 85, and has taken care of herself well, including driving on her own to the DMV to renew her drivers license just before her last birthday, things have been more difficult since then.
There are good days and bad.
Living in Anchorage makes it hard for me to look after her the way I feel I should.
Moving to Anchorage is not on her list of options.
Her caregiver is terrific and eases my conscience a little, but she's not superwoman.
I talked to Hospice folks yesterday.
Death is inevitable for all of us.  Handling it well is not.
My mom has always said she didn't want to be dependent on others.
So this chart and the article from The Dish were of some solace to me as we wander this thorny garden.
"When hypothetically on the cusp of death, physicians overwhelmingly decide against life-prolonging intervention, with the exception of pain medication."

Image from The Dish

Ventilation sounds particular gruesome:
First, few non-physicians actually understand how terrible undergoing these interventions can be. [Murray] discusses ventilation. When a patient is put on a breathing machine, he explains, their own breathing rhythm will clash with the forced rhythm of the machine, creating the feeling that they can’t breath. So they will uncontrollably fight the machine. The only way to keep someone on a ventilator is to paralyze them. Literally. They are fully conscious, but cannot move or communicate. This is the kind of torture, Murray suggests, that we wouldn’t impose on a terrorist. But that’s what it means to be put on a ventilator.

This, of course, is the hypothetical. When actually faced with a choice to let one's life go, I suspect many people have second thoughts. 


  1. Steve, I appreciate your quandary at being so far from your mother. It's a difficult time.

    Living in Alaska presents its own unique set of challenges when things such as this arise.

    My mother, although she had been, relatively, ill for quite some time, passed away, suddenly and unexpectedly, at a young age (64) a little more than 48 hours after I arrived from Anchorage. What we thought was another of many hospitalizations was not the same. No one anticipated she would not leave the hospital and return to her home.

    While I was aware she had a DNR on file, I never quite understood the irreversible finality of that decision until I was at her side and hospital staff would not assist her in those last moments. The helplessness I felt, as I appealed to them, was met with a disconnect because of the expressed, written wishes of my mother.

    I wondered then, as I have many times since, if her decision would have been different, when faced with the reality of it, to give us just a little more time, which, then, must be weighed against the quality of that time for her.

    It gives me pause when considering my own wishes - what to do to make it easiest on those left behind. We just do the best we can.

    I wish you strength and peace in your heart.

    1. Thank you for your comforting words. You raise a point I wasn't thinking of - younger people who perhaps are not terminal. My understanding of the DNR (Do Not Resuscitate) orders, is that these are for people who are already in very compromised condition and are not going to get better. It might be followed if someone young were in an accident and the brain was severely damaged. But I would think if there was a chance of recovery it would not. The way you write makes it sound like your mom had more reasonable quality life left. I'm really sorry for the shock you must have encountered. Also, there's a big difference between 64 and 91. I think at this point the DNR makes sense. My mom does not really want to go on if she cannot look after herself and move around on her own. But none of the choices are good ones.

    2. Thank you, Steve!

      Dealing with it all, intellectually, is far different from the emotional impact of the moment, which is the point of the living will/end-of-life issue, I guess. Beforehand, it all seems so academic, rational and devoid of emotion, similar to organizing your shopping list prior to being in the store and faced with impulse buying. We give it a go.

      Because of my being in AK and her only immediate family, my mother tried to make certain she removed any additional burden or decision-making from me and had everything addressed - tidy, efficient, independent woman that she was! We had spoken of her wishes, but only in the realm of their being out there in a galaxy far, far away...

      I commend you and your mother for looking forward.

      Again, thank you.


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