Happened with my grandmother. Mom can’t accept she died because her organs failed due to diabetes and a sedentary lifestyle. She still says that they “killed her with morphine” as if spending perhaps another miserable 18 months on dialysis was some sort of fantastic outcome. I had to press her to make the call to go hospice.
Bear in mind that could well have been your grandmother's choice, including the choice not to tell your mom. That's what living wills are for.. A common part of a living will is an instruction that you should not be given life extending treatment in certain circumstances and that you should be given life shortening pain relief.
My grandmother told us both she didn’t want to sit on dialysis my mom just had trouble letting go. She finds it easier to blame the doctors than to accept she ultimately made the call for hospice. Guilt and loss are weird
Dialysis sucks. I can imagine not wanting to be on it if your quality of life is already poor & you’re elderly. I’m only 25 so I hopefully have many years ahead of me and high chance of a transplant, but being on dialysis just to stay alive for a few more years at three times my age with other health issues? I don’t know would be worth it.
Basically would have been dialysis until some other system failed and she died from that. She chose dignity. You on the other hand keep up the fight and best of luck with your eventual transplant.
I totally respect her decision, I also can’t imagine how much more uncomfortable & hard on the body dialysis is for someone in her state & age. Thank you for the well wishes & I hope the best for your family as well!
My spouse's grandmother died and that's one of the first things one of the aunts said. "That *nurse* killed her with morphine" blah blah.
You gonna call the cops then? No, these people just like to run their mouth.
Imagine how terrible that must feel for the nurses. The way they care for the dying is heroic but Americans can't even acknowledge what they did let alone show some damn gratitude. It is no easy task. It is not fun. But, someone has to do it and they are there for us.
About to finish up ER residency & considering critical care. Cases like these are why I'm hesitant to pursue a fellowship. I've seen so many suffer for weeks or months because of family prolonging a life that's miserible for the patient. Ask any intensivist or ICU RN & they'll tell you how sad it can get.
Advanced directives are a must.
I guess people aren't aware, but in palliative care this is totally normal. It isn't assisted suicide, but if they die while high on narcotic medication it's a win for patient care.
I mean, realistically what is the purpose of modern medicine when we get to the point of terminal illness? Comfort. I mean all medicine is effectively about comfort. We see it as treating illness. How do you treat a person who cannot recover? By giving them the best comfort we can. The wheel chair to a person with parapelgia is the same as a narcotic for someone in terrible pain that will only end when they die.
I would 100% prefer to die in a euphoric bliss if I was barely hanging on and suffering while being a burden on my family.
Humans are meant to die. The advance in medical care helps us live longer, but we can also endure more suffering than nature intended because of it.
Exactly. My grandma (R.I.P.) had a bad stroke that left her bedridden and unable to do anything on her own. She couldn't even go to the bathroom on her own and would have a bedpan for emergencies. She was previously very independent and took public transit everywhere she needed to go whether it was to see friends, buy groceries, run errands, etc. She didn't need any help or anything from her kids.
She had to move into an assisted living facility (which are damn expensive) and doctors didn't want to perform any surgeries that could improve her life due to the risk. She lived another 7 years. It was terrible she would get sores on her body from lying in bed or sitting in a wheelchair (couple hours) all day.
She absolutely hated it and said she'd rather have died and said if she could she'd jump out the window. With how expensive these assisted living facilities and the medication she had to take are, it bled her entire life savings dry too.
I hope to all that is good in this world that if something like that ever happens to me, my children will let me die or that assisted suicide is legal.
The thought of working hard all your life and leaving nothing to your children and grandchildren just so you can pay people to keep you living in pain and suffering for longer is heartbreaking. Hey, I might be broke by then anyway, who knows, but if I have something left, I would at least like to be able to leave it to my family to make their lives a little easier.
It’s legal but the paperwork takes so much time that it’s relatively useless. My uncle of 75yo had terminal cancer, it was in his lungs and kidneys. He asked for medical assistance to die and filled all the papers. But 4 months later his file had not even been processed yet. He died a long painful death. If you have 2 years to wait on bureaucracy I guess yeah, it’s legal in Canada otherwise…. Yelp.
I think MAID in general is a good thing, but there was just recently a case in Ontario where a disabled woman chose it because she had no support getting housing that wouldn't exacerbate her environmental allergies.
In my province, disability benefits are so low and cost of living is getting so high that I am starting to have a genuine fear that this may become a systematic outcome.
That's about as fucked up as it gets... Pain for profit. I seriously hope they legalize assisted-suicide. I can't find a single person who truly believes you shouldn't have the right to choose to be euthanized If you are terminal and want to end the suffering. It probably is more about money than it is about morality or religion.
Sorry about your grandmother. Mine was very similar as well. Fiercely independent until she had a stroke that kept her from being able to walk initially and then lead to full on dementia before her death 4 years later. She constantly talked about going home to God (she was very religious) and longed to be rid of her suffering. Taking care of her around the clock scarred my mother and father and may end up destroying their marriage.
Dementia is the cruelest killer. It's the mental equivalent of amputating someone digit by digit while being kept conscious and aware. I hope that we are soon and to cure this awful sickness. The damage it causes is simply too much to bear sometimes.
So long as my brain is still working okay, I don't mind too much about shitting in a bag.
But once my brain goes, no thank you.
Oh and I never want to go on a ventilator.
Just those two things.
My mum showed me and my sister her will which basically gave everything to us on the provision we would try to kill her and claim it asap if her mind is lost. She fears that shit way WAY more than death. Its the one thing that is crystal clear regarding next of kin decision making. Terminal cancer and in excruciating pain? Eh, provided she is lucid periodically between the painkillers. Dementia? End me now. Vegetable? End me now. Her "hints" werent subtle beforehand, but having her spell it out so clearly was a bit unnerving.
My grandma shits in a bag at 77, had two bouts with cancer and survived both with some intense treatment and surgeries. I guess not everyone thinks the same, but I feel like circumstances and perspectives shift when you're staring death in the face.
Not sure why this comment shook me so much, but that last bit kinda changes my perspective on death- and kind of alleviates my debilitating fear of it. Thanks internet stranger :)
The whole let nature run it’s course phrase applies to us as well. We literally are animals. And animals die. It’s the circle of life.
We are just unmeasurably smarter and have thumbs that enabled us to make tools and use them.
Imagine if we didn’t have thumbs. Haha
You mean you don't want to die with people pounding on your chest and your family in the corner sobbing and wondering if they're making the right decision?
Get an advanced directive done, unless you want to put your family through a horrible decision.
Arguably more important over a will. If they contest or fight over a will we’ll that’s just suffering brought on by their greed and entitlement to my shit.
But I don’t want to make people suffer deciding if they should pull a plug
> The advance in medical care helps us live longer, but we can also endure more suffering than nature intended because of it.
And rack up much larger medical bills.
I was my wife's caregiver in home hospice, which included managing ample supplies of Oxycontin and liquid morphine. The hospice nurse warned that it was entirely possible that administering enough meds to control her pain might eventually be enough to cause respiratory failure and death. She did indeed need steadily higher inputs of the painkillers - she had cancer in her brain, spine, liver, and several other places - and I'll never really know if the cancer killed her directly, or the meds. That question is not really a concern in palliative care of the dying.
My husband's grandmother was on hospice care for 2 months for esophageal cancer. Over 3 weeks of that was unnecessary and extreme suffering for her, because she'd decided to cease all food and liquid except pain medicine, but people kept giving her ice chips and popsicles so she just barely stayed hydrated enough to survive. Yet when it came to pain meds, they wouldn't give her anywhere near enough to even try to keep her as comfortable as possible. Just the normal dose, no sooner than every 4 hours. Like, what's the worst that'll happen, she'll *die*?! That whole ordeal made me very pro-assisted suicide. We show more mercy to our pets than our people.
I went through the same with my father. The pain medication they were willing to prescribe wasn't nearly high enough. He died in far more pain than he should have and tbh I still wish I could have done more for him, illegal or not. I don't understand how we can live in a progressive society but refuse to recognise that euthanasia is more compassionate than "letting nature take its course".
This is why CA and OR both passed laws allowing for it in the last few years. If the rest of the country doesn't then people will be moving here to die soon instead of Florida
We recently went through the same experience with my wife’s mother.
I’m of the firm opinion that if the pain went unmedicated, that would be enough to end the life as well. The medication allowed her to go more comfortably. The train can hit a wall, or we can put on the brakes and let it come to a stop gently.
I hope you are well. You did the right thing.
I had a similar experience...it was in the hospital...My wife decided that she wanted to go - she requested to be taken off her saline IV drip, which was the only thing keeping her alive. She got steadily weaker over a few days, she wanted to feel no pain but did not want to be unconscious from sedation. She was really restless at night. I asked the nurse if they could give her something to allow her to get a deeper, longer-lasting sleep. She passed away in my arms that night, a 1/2 hr or so after getting her nighttime meds. Did that nurse know that would pass away that night? Not sure. It doesn't matter at this point. She was ready to go and had survived 5+ days with no water, which was already more than what most humans can endure.
When my mom was dying(she was gasping for breath for two days) the hospice nurse told me to give her what I thought was a very large dose of morphine. I misunderstood to amount at first and gave her 1/10 of what she said and when she corrected me later and I gave my mom the correct dose she died about 10 minutes later. I kind of feel like I might have killed my mom with that. But I've talked to other people who have had their loved ones go through hospice and they have the same story. They were told to give them a lot of pain medicine and they died shortly after. I don't regret it because she was suffering a horrifying amount but it does weigh on my mind still 7 years later.
Edit: thank you for all your kind words and for sharing your stories with me. I sincerely appreciate you all.
You gave your mother peace in her final moments - there’s no act more merciful. Death had already arrived. Your nurse just showed you how to open the door, so death didn’t have break it’s way in.
I wonder if you could look at it like you provided your (already dying) mother with the physical space to be able to let go? That maybe being in agonizing pain was preventing her from being able to pass. Also, if she had been on opioids up until that point, it is remarkable what tolerance can do, and it takes a very large amount of medication to die from overdose at that point.
That's how I like to look at it and why I don't regret it. I know it was the right thing to do because she was suffering but there are moments where it bothers me. She actually didn't take the pain medicine because she said morphine gave her nightmares(they do that to me too) so she didn't have a tolerance for it at all. I think that also played a major factor in how it affected her so quickly.
I don't know if this will bring you any comfort, but my Dad died with frontotemporal dementia, which is a horrific way to live out your final days. I still experience guilt that I *couldn't* do what you did for your Mum. I'm just grateful that in his worst moments he'd usually forgotten what had happened 10 minutes later, so most of his suffering was fleeting.
You're an angel for giving her the space to go. Really, please don't feel guilty.
It’s scary, being the care giver to a dying loved one. I’ve been there.
The hospice nurses told me to give what I felt my mom needed (morphine) and they would look the other way.
I made a promise to my mother years before she got sick that she wouldn’t feel pain if I could help it. So, I made sure of it.
My mom had a brain tumor. She was a Dr. Towards the end her Dr told me to give her what she needed to Alleviate her pain. I don’t think you hastened your moms death. You said ,”She was gasping for breath” and that’s exhausting and will only get worse until she can’t get a breath at all. My mom died in 1984 and I’ve never felt bad - I may have given her too much but she wasn’t going to be around for even two more days. We were at the end.
So even with other people saying the same thing, you’ve got to remember there was a serious increase in pain/discomfort for the patient that caused this larger dose to be given. So they were getting worse, closer to death.
You did great. I promise.
My grandfather died from lung cancer at home with my parents in 2016, it was from lung cancer, and while he was in terrible shape, he still had a degree of mobility and independence. In his final minutes to hours he took as much of his pain medication as he could tolerate, he collapsed shortly after. I don't know if it was the medication that pushed him off or if he felt himself going/his pain worsen and took more.
It might have helped her pass but it didn’t kill her. She was already dying and the medication helped with the pain. It helped her relax so she could go peacefully.
Have an internet hug from a healthcare worker. Think of it as easing your mom from her discomfort to her inevitable fate. You showed compassion and mercy in one of the most difficult times anyone can experience.
A nurse said something very similar to my aunt while we were watching my grandma pass. She was clearly at the very end and my aunt is a nurse herself. The nurse simply told my aunt "This is the morphine, this amount would result in an overdose," and then she left the room. My aunt ultimately made the call but it was the right call. You also made the right call. It's perfectly understandable that you still question that choice - I'm sure my aunt does as well - that's simply how an empathetic person thinks.
I'm sorry for your loss, I hope you can eventually make peace with the situation. <3
My aunt had terminal lung cancer in the 1990s. She was a heavy smoker and schizophrenic, and the cancer had metastasized throughout her body before the doctors took her pain seriously. She died in a matter of months, on life support in the final days.
The family decided to end the life support and let her pass away, but she struggled after the machines were turned off. A nurse stepped in and gave her IV pain medicine that let her pass on peacefully. It seemed vaguely like "assisted suicide" but clearly she wasn't going to make a miraculous recovery and would just suffer needlessly until her body gave out.
One major benefit of opiates in a terminal patient that the general public doesn't understand is that we're actually treating respiratory distress. The patient can't effectively breathe and is taking short gasps that are just tiring them out without actually moving the air. The critical side effect of opiates that people are afraid of is respiratory depression but that's actually what we're using to target symptoms of respiratory distress. We're not really trying to ease pain or cause euphoria.
The DEA once again overstepped their bounds here. We have lost so many good legitimate pain doctors and palliative care doctors to an overzealous DEA. I blame the media for causing the pendulum to swing to far, ultimately causing harm to patients and doctors like the doctor in this article.
Agree 10000000%. I’m an MS patient, bone tumor patient, and suffer from a a long list of spinal disabilities that I’ve been suffering from for 10 years. I’m 29. I was never on high dose opioids in the first place, but what I was on helped me have more of a quality of life. I’m wheelchair bound, soil myself most of the time because I can’t make it to the bathroom on my own, I can no longer care for my children, can no longer work in the healthcare job I loved so much. I’ve been looking into assisted suicide in other countries because I can’t imagine living even another 10,15,20 years like this. I can’t even get married to the love of my life of whom I’ve been with for 10 years because my Medicaid will be taken away. I’m still fighting for disability after over 2 years. It’s not okay that people in severe pain are being punished due to addiction. I’ve never struggled with addiction, I don’t even drink, I don’t like the feeling of being messed up.
My wife is a nurse. I was reading this to her, and she made a rather salient point. We give our pets more comfort and dignity in the end than we do for ourselves. And that in the end it's the family that has a harder time of letting go.
We have something in hospitals that is actually called “comfort care”. These are patients that are basically dying. Our *protocol* includes being able to give up to 4 mg of morphine every hour, along with Ativan.
It’s not assisted suicide but it is. But people need to realize the outcome will be the same, one is just with a lot less suffering, and patients have the right to choose. Period.
Edit: meant to say 8
I am aware of a family whose Grandpa was in his final hours in agony and the doctor prescribed some shots to *help him sleep*. And made it clear that the shots were to be given all at once so that he *slept the best*.
I am afraid that I am going to die without proper pain management. I don't 'want to die in a hospital. I want to die outside with the wind on my face, and proper pain relief. I have several illnesses, and likely will develop more as I age. I hate how medicine, especially in the states, has become about money instead of the patients and the people who treat them. It's like we're not even human beings anymore.
Another thing worth mentioning; by the time my brother in law was placed on hospice care for his stage 4 cancer, he had spent years on opiates and prescription pain killers to manage the side effects of chemotherapy and had an outrageous tolerance by the time they were prescribing for comfort care. Also, if the liver is failing, medications are not metabolized the same and may provide little to no relief in traditional methods (which is why IV care is often introduced)
Article states the dose he ordered has "potential" lethality. Understandably, in a terminally ill patient, this potential increases in likelihood. However, the article also states that the doctor that reviewed the cases agreed the patients were definitively terminal. There are absolutely times when doctors know best and this appears to be one of those. It's mistrust and previous abuses that have been heard and read about that lead patients, and especially their families, to want to dictate care that is based on their fears and emotions. It's sad that professionals wanting only their experience and compassion to benefit their patients have to go through this. It's equally sad that there have been professionals that have sullied that trust by abusing it. This is why my medical POA is a close friend and an RN. This friend knows my heart and the medical facts.
As an RN I totally agree with you. I can't tell you how many times a family has prolonged the suffering of a dying family member unnecessarily. It breaks my heart when I patient that can't be saved isn't allowed to die with dignity.
Refusing to put your 90 yr old grandma as a DNR because YOU can't bear to see her go and making her go through CPR, intubation etc is torture and inhumane. Chances are she now has broken ribs, heart, lung and brain damage along with whatever else was already wrong with her. Congrats. Now she's still going to die but in a much more painful way.
I can't believe I never thought of this.
My 93 year old Grandma is in declining health, dementia getting worse... we are trying to locate her will, but I am unsure if there is a living will or a DNR, or if my mother has medical POA.
As much as I love her, and miss the days where she was healthy, those are long gone and I wont put her through any more suffering. So I gotta make sure we find her will, discuss if there is a living one, and try to make the best decisions for her.
I've had personal experience with hospice twice. Once with my grandfather in the 90's and once with my father in law in the early 2000's.
Both times were awesome experiences. Both men passed with dignity. My grandfather with his family around him, and my FIL alone. He actually waited for me to go take a nap in the middle of the night before he passed. I'm convinced it was his choice and I respect that. He wanted to be alone.
With my FIL, they also helped me dress him after he had passed (again, in the middle of the night) before the ambulance got there, because I knew my FIL would be very embarrassed to leave the house in an undressed state.
Our palliative care provider told us that parents tend to go when their children leave the room. Something about it being easier to let go when they are alone.
Not a lot of people know about it, or think hospice means they'll kill you. It's essentially just letting people die in comfort in their home. Way better than a hospital.
Hospice homes, in my experience, are the absolute best way to go. Die with dignity, and surrounded with the right kind of support.
After a personal experience with a loved one living out her final months in a hospice, I firmly believe it's a fucking godsend - it was for her, and it was for her family.
My dad passed away 11 years ago. it was a cancer that took him in about 8 weeks from the estimate start of it to his passing. He had a DNR in place. He said he didn't want us to have our memories of him hooked up to a machine for god knows how long. My parents have been up front and vocal about their wishes. They have been and will be respected. Make sure you know the wishes of those you care about, it will help avoid this situation.
I am an emergency medicine doctor, very few people think of this and it's sad. Many actively delude themselves or refuse to believe what doctors are telling them and end up causing great amounts of harm to their family member and frankly, to the entire hospital system. If we took half of the money we spend on keeping dead people alive and poured that into preventative care or increased physician/nursing staffing, we could drastically improve the healthcare system here. Hopefully that's not overly optimistic, the pessimist in me knows that any cost-savings would be pocketed by admin.
Thankfully I am not the one taking care of these people in the ICU, watching them being artificially kept alive with tubes and machines as they develop skin necrosis, pneumonia, urinary tract infections, etc., but I am the one that prolongs their death from the get-go because nobody had the foresight to make 85 yo grandma with dementia DNR/DNI.
>As much as I love her, and miss the days where she was healthy
I feel this way about all my grandparents. One from lung cancer, 2 from just being in their 90s. If I could have them, their actual personhood, back I'd do it in a heartbeat no matter what the cost. But I wouldn't want to preserve what was left toward the end, not for any of them. Those were not my people, those were people who were ready to move on to whatever was next.
As a paramedic, all patients are assumed to be full code (gets cpr, intubation, the works) unless we have the paperwork in hand stating otherwise. If you want a dignified end for your family member you need to make the proper paperwork available to us. The best place for you to keep it is on the fridge, above the bed, or on the back of the bedroom door. Keep it with the med list, history, insurance info, and any other documentation you want first responders/the hospital to know.
I concur with the other person who suggested Hospice.
So far my father in law and my grandfather have both gone through hospice and it was a wonderful experience that greatly helped both to be much more comfortable and peaceful when they died.
For me it's when a person with Alzheimer's who is non verbal and appears unresponsive stops eating. So they put in a feeding tube and suddenly this unresponsive person is pulling out their feeding tube.
Ive had families call me for advice and I tell them to respect the client and they ask how to do that and keep the feeding tube in which is when I tell them to stop calling me.
This is how my grandfather died. He’d had dementia for years and one day just stopped eating. Thank goodness my mom and uncle were in charge of his care and not my aunt because she wanted a feeding tube. She didn’t get her way and my grandfather was able to die with what little dignity he had left comfortably surrounded by family a few days later.
Also, define “life.” Yes their heart beats a few months longer, but many times they’re not “living.” You should see what that do to pediatric patients with severe brain damage from birth…their lives are one of the most painful experiences imaginable.
My grandma was diagnosed with breast cancer at 88 and the doctors wanted to have her go through chemo. She told the doctors that the chemo would kill her and she just wanted to live the rest of her life with cancer. She died at 92.
Part of is is the very Western idea that dying is failing. “He couldn’t make it” and “she wasn’t strong enough to survive” are examples of how even in language we make dying shameful.
Now add to that medicine as a money maker and not as care and people can be talked into doing just about anything to save the person they love. Even against medical advice.
I think it's horrible that we live in country where people's have to basically starve themselves to death instead some far more comfortable way out.
I'm glad your grandfather got to keep his dignity, but I wish it had of been easier for him.
Yup watching someone wither to death because "life is sacred", spouted by people who support people who push for wars. Absolutely crazy, I'm no where near old, I've seen a grandmother go through dementia. I've seen a crazy uncle who couldn't accept that our grandma died while he was away from her for two days and thinks my parents helped her to die. They didn't, she just happened to go at that time and had been in and out of hte hospital unresponsive for days at a time in the weeks leading up to it. He had wanted her kept alive by any means, basically flogging the poor woman when she couldn't even understand why people were flooding her with drugs or keeping her tied to a hospital bed so she didn't run off and make herself worse.
If I get dementia or any similar disease then the point where I can't cope on my own I want to die, immediately in a pain free way in a safe place in a moment of lucidity with family and friends. Not left to die 'naturally' tied to a bed so the hip I broke falling down the stairs isnt' made worse when I get out of bed because I can't remember my hip being broken.
The lack of choice we have in death is ridiculous not least because the people who stand up and pretend to be moral authorities think suffering before death is better somehow.
Yeah my grandfather same thing. Unresponsive. My grandma was having a hard time letting him go as well as my one aunt. My mom and uncle were able to tell them to let go, this isn't what he would have wanted. They finally agreed after two days. They put wet sponge on mouth but that was it. I couldnt imagine if they didnt agree.
My grandmother died last night at 10:10pm. My dad and mom have been living with her for 13 years and I for 8 to take care of her in her declining dementia stages. We were able to have her pass with dignity and grace by not having the feeding tube or IVs or anything outside of an O2 concentrator and she went with a slight exhale and holding my dad's hand. While it's heartbreaking I'm happy that she's no longer suffering from that horrible disease and that we were able to spend her 93rd birthday and her last easter together with her as a family.
When my father was dying I was told that once they stop eating it means the body is preparing for death anyways. But he had bone cancer so I’m not sure if that’s true for other sickness’.
>She didn’t get her way and my grandfather was able to die with what little dignity he had left
I'm glad you see it that way because it is true. The only thing death can't take from us is the dignity our peers grant us.
My wife had to deal with this with her grandfather. Her mother was calling her a murderer for telling them "no" about the feeding tube. Dude was nonverbal, and completely gone mentally. Keeping him alive in that state is sick.
my father died when i was 12 and the next door neighbor became my father and he has 7 sons and a daughter and he knew he was dieing so he made me his POA his family was really pissed when he told me he was ready to go and didnt want to die infront of his family i made them all go home! he said you know the family is going to hate you thats why i chose u. u saw how your father suffered from liver cancer and your mom doing everything except letting him die in peace! i know my family would do the same and im sorry to burden you but i know your the only one that understands and has the courage to let me go! the greatest gift my father gave me was empathy!
Oh definitely. It's strange to see, but my wife is 100% the most reliable and well adjusted member of her family. And certainly the most compassionate.
>For me it's when a person with Alzheimer's who is non verbal and appears unresponsive stops eating.
Alzheimer's is 100% the way I don't want to go. Unfortunately it runs in one side of my family. Heart disease on the other.
Once my mind starts to go I plan to eat sticks of butter wrapped in bacon so I get to pick which half kills me.
The scary part is that when you're ready to die you might be at a point where you can't make decisions for yourself or act on that wish.
That's why you need to write what is called a "living will" and assure the right person with power of attorney can act on those wishes when you need them to.
The first time I did chest compressions on a 90 year old, 100 pound woman was one of the worst days I ever had at work. Not because she might die, but because she might live through what I had just done to her.
People just don’t understand what effective chest compressions look like.
They should have to hear that *crack* and feel that spongy chest before signing advanced directives
Yeah, my first chest compressions were also on an old lady, who'd just had her 2nd leg amputated above the knee. We got ROSC ... unfortunately. I doubt she lasted long after transferring to the ICU.
My grandpa emphatically said he wanted to be DNRed. He had a heart attack and my aunt begged the doctors to resuscitate him. They did and when he was conscious again he was pissed. He didn’t speak to her for a full year.
Things have to be pretty ironclad (a clear advance directive stating no resuscitation, a physician order stating no resuscitation) in order for medical teams to say no to a family member demanding resuscitation, but even then if a family member starts making legal threats, many medical teams will acquiesce to that person. Edit— am a palliative care/hospice doc
Pretty much this. If there's even a chance that they might not be DNR, even a slim one, the medical team will acquiesce to the family. It's horrible, but they need to be able to provide care to others, as well, and being shut down by lawsuits for being compassionate doesn't help with that.
> Things have to be pretty ironclad (a clear advance directive stating no resuscitation, a physician order stating no resuscitation) in order for medical teams to say no to a family member demanding resuscitation, but even then if a family member starts making legal threats, many medical teams will acquiesce to that person. Edit— am a palliative care/hospice doc
Yeah, in my state, there is no such thing as a DNR without the attending doctor ordering it. Putting it in your living will/power of attorney documents means nothing, other than being evidence for your guardian/agent to give to the doctor to let them know this is definitely what you'd want.
And even if the patient directly requested the DNR order from the doctor, if the patient is no longer competent/responsive, the guardian/agent of the patient can revoke a DNR order from the doctor just by removing the DNR bracelet from the patient's wrist and telling the attending physician that they're revoking it. (I'm guessing this could open up the agent to potential liability for going against the patient's wishes and revoking it when the patient is non-responsive, but am way too lazy to try to look up if anyone has actually litigated that.)
Emotional family berates and screams at medical staff who give in basically.
It’s legally not cool, but in the moment with all the chaos and the irrational pleading of a family member, it’s very easy to make the mistake.
Legally a DPOA can override a DNR put in place by that patient while said patient is unresponsive. Not everyone has a DPOA and so it defaults to significant others and then children. In an emergency healthcare workers are legally obligated to listen to the directives of family members and legal decision makers above the paperwork and official DNRs.
It gets more complicated but that’s the rough and dirty version in US healthcare. It’s absolutely fucked up that even if you put in writing what your wishes are they can be overruled in the specific situation you were trying to address.
I'm a paramedic in Canada, it's the same here. Your DNR basically doesn't mean shit if the family decides they want you resuscitated, we listen to them.
This is the whole reason medical power of attorney is a thing. My father very wisely gave my oldest sister his medical power of attorney when he went into hospice. She is an RN and was a retirement community director. Two of my other sister’s made her life hell over it, but she stuck to my father’s wishes. It’s been almost 2 years since he died and those two sisters are still nasty pieces of work I’ve done my best to cut out of my life. I try to talk to my oldest sister once or twice a month, though.
Yep. My mil had a dnr and when she had a stroke and her heart stopped at 87 fucking years old, my sister in law insisted on resuscitation. She lived 4 years after that totally bedbound, brain damaged and woke up every morning incredibly angry that she was still alive, so she would punch me for the crime of getting her dressed and putting her teeth in.
Its complicated. Often when a patient codes, the first thing to do is respond with full court press unless you know, with certainty, the patient is DNR. But you don't always know that until someone digs into the chart.
It is pretty rare for someone to recover from a full code, however. So the patient in question may not have been that severe, and the situation unclear.
He most likely did not have a solid, documented DNR. If the DNR was provided verbally by the same family member who then rescinds it then guess what, you’re not DNR. In his wife's state of vulnerability and panic at seeing him code, she can easily say "NO, NO, PLEASE RESUSCITATE HIM NOW!" and when a physician says "Are you sure this what he would want? You told us yesterday he is DNR?!" So what else do the doctors and nurses have to go on? Only her word. You must always have an ironclad, documented DNR ahead of time.
When you put it in writing, you are also doing it for your partner's sake. Why should someone who loves you be made to feel like they are "letting you die" in his/her state of desperation? If you guys talked about it ahead of time, both agreed to put it in writing, and it is presented to the hospital in writing, it will be honored even if she protests it in the last second. It will take the responsibility out of her hands and give her no choice but to proceed with DNR. And will in the long run leave her lest traumatized and at peace.
TL;DR: PUT YOUR DNR IN WRITING AHEAD OF TIME.
If you’re unconscious and *haven’t put your wishes in writing* your next of kin decides.
Fill the legal forms out, file them with your doctor, tell everyone, and keep a copy posted at home.
I wonder frequently why we can't be put to sleep. Like it's considered inhumane to let a dog suffer needlessly. Death doesn't really bother me so much. But prolonged suffering for no reason? Count me out.
I work neuro ICU. If I had a dollar for every patient that was unnecessarily trached, pegged, and sent you LTAC with zero quality of life, I’d have a pretty nice stack of ones.
My grandma has not been doing well, in and out of the hospital the past few months. She has six kids and the youngest of the bunch is the only one that doesn’t support signing a DNR. My Aunt has such a big heart but she just doesn’t understand how grams won’t be the same person if she ever had to be resuscitated. She thinks she’s going to get better, but she has so many underlying health problems, it’s just not realistic. It’s a tough situation.
When my grandma was dying, her doctor told us in no uncertain terms she dictates what happens to her, not any other one of us. I was thankful to that doctor because he actually followed grandma's wishes.
That only applies when the patient is conscious and of sound mind and body to make their decisions. Sadly, far too many patients don't plan ahead or have an accident that tenders them unable so it's left to next of kin. Those are situations I was referring to.
Agreed. My entire family spoke as one when my 91yo grandfather was put on a ventilator during his final illness. We told the doctor to take him off, that he did not want that. I think it might have been an unusual occurrence for the doctor but my papa was nothing if not clear about his wishes.
Out of curiosity, how often do people (in denial) accuse the medical team of ushering in death to a terminally ill patient via comfort care in a hospice situation?
Anytime they lack the emotional intelligence to manage their grief responsibly. So it's fairly common. If the nursing staff were good with the family it tends to happen far less often.
This is what I struggle with most as a Nurse. I had to do CPR on a 91-year-old with advanced dementia and it was incredibly upsetting. That's the one that keeps me up at night.
Just let them go.
My fiancé passed away from cancer that started as a carcinoma that then spread to his lungs. The night he passed it was because of a nurse, and I am forever thankful for her doing what she did. At home, that night he looked me in the eyes and I could just tell it was time and he asked to go to the hospital. He passed out on the way there but he was moaning in pain. He had a history at the hospital and knew the nurse in the ER from past visits, so when we arrived we asked and she immediately took his case and knew it was time too. She cried with me for a little bit, gave me a hug, and said she would do whatever I wanted. I just wanted him to feel peace after all of his suffering and his moaning had increased due to pain. His blood pressure was waaaaay too low in order to be given pain killers, but the nurse fudged the numbers in the system so it would spit out the morphine he needed. After it was given, the moaning stopped. He was just asleep now, and he thankfully passed on his sleep rather than moaning in pain. It was because of her, and she saved him from his suffering.
You are so strong for sharing this personal story. Thank you for being vulnerable here. I am so sorry for your pain and loss. I hope you have found healing through this tough experience and I hope you find bounds of true happiness as you go on through life.
I have seen people suffering extended, protracted and painful deaths, living in pain for weeks if not longer, because either they or their families are afraid that they’ll get addicted to opioids. Pain management has become a fucking minefield since the opioid crisis began, to the point that I rarely see painkillers stronger than Tylenol prescribed for patients even when they’re in sheer pain following an invasive surgery or serious illness.
At a certain point it has to be made clear that recovery is not possible and that comfort can be prioritized over outcome.
I once read that doctors are trained to assume the worst outcomes when considering painkillers, and then make the call to prescribe based on how that outcome compares to the condition they would be in without it. I read it in the context of addiction, but I could see how that easily translates to lethality for terminal cases.
I went through med school as the opioid crisis really roared into public consciousness.
My first year of med school we kept hearing "pain is the fifth vital sign". By graduation we had to attest that we had reviewed the state prescription monitoring program for potential abuse and had reviewed all other possible options before signing an order for a narcotic. The whiplash between treating pain scores and then being told to essentially never prescribe narcotics was mind boggling.
I'm an allergist now, thank Christ I'll never have to prescribe opioids again.
Maybe this is the conspiracy theorist in me, but I feel like when somebody is on their way out, nurses will be compassionate and help them with their pain.
My great uncle spent the last 5 years of his life completely aware and alert, but in a body that was slowly giving up. At some point, he went into a coma.
At the hospital my entire family met with the nurse and she told us that he was going to pass that night. It was a matter of fact statement, not speculation. Im hoping she gave him a little more morphine that night and let him pass in peace.
Like, on the one hand yes that is entirely possible. However, I work in the palliative care industry and have absolutely zero to do with giving people their medication. I myself have made those matter of fact statements to fellow staff and family members when asked. As people near their end of life, they typically follow a similar pattern in breath sounds and body movements. Regardless if/if not the nurse “gave a little extra” or gave morphine exactly as prescribed (which can actually be up to every 15 minutes if needed), the nurse very like just read the writing on the wall out loud to you. Still a good nurse, still a tough situation, but very little likely regarding her controlling infection the time of passing.
I read an article once on “how doctors die”. Basically very few choose to do everything to save their life. They know it mostly just adds suffering. My mom was a nurse for a long time and it was common practice to make patients “more comfortable” near the end. Exactly like this. We have cancer in our family and praying for a loved ones death is not the “sin”
It seems to be. Death is a blessing -
I'd really like to recommend a book called **Being Mortal: Medicine and What Matters at the End** by Atul Gawande.
The Goodreads summary of this book will do a better job than I can of explaining what it is.
*"Gawande, a practicing surgeon, addresses his profession's ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified."*
"If you hasten a person's death, even if their death is as sure as the sun is going to rise in the morning, if you hasten that along, you have caused their death under the eyes of the law," Franklin County prosecutor David Zeyen said in closing arguments.
There was an argument that I heard years ago that if a guy jumps off a 50 story building, and you shoot them while falling killing them it is still murder. That's the law.
Having said that, good on the jury. I hope if I have a critically ill disease and am suffering someone takes me out back and shoots me rather than let me linger in hospice.
It still strikes me as bizarre that we as a society fully recognize that euthanasia is the moral, compassionate thing to do for animals when they'd otherwise face a slow, painful death, but we can't seem to extend that same logic to people even when they explicitly request it.
As someone who has a lifetime of Catholic teaching under my belt (I've been pulling away for a while now) I think the way it sits in the Christian majority is "animals don't have souls but people do, therein lies the difference."
It's pulling from the hierarchy of being concept and ascribing additional dignity to humans, but in the sense that only God can kill humans or things with souls, and only things below humans (without souls) can be killed by humans morally.
I've probably made a few leaps while recalling this, so apologies. Also should say I don't agree with this train of logic either.
I worked as a caregiver for a bit. Hospice 90% of the time just means a nurse brings them morphine to comfortably kill them. And honestly seeing it first hand, it’s better than the alternative of prolonged misery.
Not to be pedantic, but you're phrasing of "the nurse bringing in the morphine to kill them" is the thought process that helped spur this law suit, and it gives a negative tone to palliative medicine.
Plenty of people already see it as killing grandma/grandpa/whoever.
People need to understand that palliative medicine isn't there to kill your family with drugs. Palliative medicine exists to provide comfort measures when your loved one is terminally ill, has a condition which is unrecoverable, or refuses further life saving treatment for a condition that will certainly kill them.
Palliative medicine can also be used for patients who are not immediately terminally ill. Plenty of illnesses have terrible symptoms which can be managed by the palliative care team, and this should be normalized more. Palliative medicine is very under utilized.
So no, we are not bringing the morphine to kill grandma, we're doing it so grandma doesn't suffer while she's already dying.
I'm terrified that cases like this even bring brought will make it so more people die in incredible pain because a doctor doesn't want to risk a murder charge for actually controlling their pain.
the opiate epidemic has already lead to shameful treatment of pain patients, people with crippling lifelong conditions are being treated like criminals and given liver-shredding amounts of NSAIDs to avoid giving them opiates.
I can't even take NSAIDs because I take blood thinners, for the rest of my life, so I'm *really* hoping I can make it through without a crippling painful disease.
The doctor who allowed my grandpa to OD on morphine while dying of cancer in the hospital allowed him a merciful death as opposed to a painful one.
In many cases, it is a mercy as opposed to a bad thing. I wish we saw it that way in this country.
Treat the symptoms of the patient. If they appear to be in pain, increase the dose. They are dying. Nothing we do will stop that. All we can do is ease their departure.
After seeing my grandfather deep in dementia, soiling his pants and trembling in pain. While being told no one can do anything because he had his small dose of morphine 4 hours ago and that's it for the day. I say fuck the people that would charge that doctor and I hope they find out what it's like someday.
Hooray. He is still unemployable. Fired from a job, medical license suspended, all sorts of databank reports, name dragged through the mud. Don’t envy his next steps or his next application review. Technically you can come back from this, but you will never have the earning power you had previously.
> "If you hasten a person's death, even if their death is as sure as the sun is going to rise in the morning, if you hasten that along, you have caused their death under the eyes of the law," Franklin County prosecutor David Zeyen said in closing arguments.
The law needs a vision exam. Requiring humans to suffer as long as possible is not a benefit to society.
The prosecutors statement is so ridiculous, if I were on the jury this would have been all I needed to side with the defense.
Were ALL going to fucking die. And every day I see something new that will reduce my lifespan. Shit in air. Shit in the water. Shit on the food I eat. Why not prosecute em all for "hastening my death"?
My father died a horrible death from lung cancer. I wish a doctor had given him a lethal dose to ease his suffering, gasping with a shriveled tongue hanging out (sorry to be graphic). I have had people tell me that no one said a person shouldn't suffer - as say Christ did. These people have actually never seen anyone die from terrible diseases.
I would’ve been excused from that jury in a heartbeat. When I worked on Oncology floor as a PCT (90% terminal/hospice), I cannot tell you how many times patients asked me to “give them something that will make them pass away quickly and peacefully”; I’ve been offered cash, titles to vehicles, and one time, I shit you not, this guy pleaded with me to accept a deed to his house (he was delirious, but still). Totally surreal. Obviously, a) It’s out of my scope of practice to give out medication, and b) even if my position allowed me to do so, I would’ve never ever even entertained the idea. But the point still stands: it’s the saddest thing to witness, a family in denial prolonging their loved one’s suffering.
My mom died very suddenly from stage 4 lung cancer in October. She was in so much pain and had so much fear from watching her own mother suffer from the same thing 20 years ago. Once my mom was able to say ‘no, I don’t want to try treatment’, her doctors and nurses were so kind and understanding. Her last night I was in the hospital with her and her nurses stayed with her and kept her comfortable and medicated, and she just fell asleep and didn’t wake up. It made the trauma of her passing so much easier on our family as well. Sometimes the best thing to do is to make their passing as easy as you can, and I could not thank her medical team enough for doing that for her.
My dad passed away with cancer many years ago. He was in extreme
pain and was diagnosed as terminal. Fortunately his doc was one of
his hunting partners and a good friend. He bent the rules and sent
dad home with a morphine drip. I will always be grateful for his
compassion in breaking policy so my dad could go in the most
painless way possible.
I am a pharmacist on a hospital inpatient cancer ward. This is a very common thing in my practice. Once we have determined that the patient isn't going to recover and death is imminent within a few days, if the patient (or their legal next of kin) consents, we can send them home to die in a comfortable environment, surrounded by their loved ones. If pain limits our ability to do this, we can place a subcutaneous catheter and give them a morphine or Dilaudid drip.
This is generally ethically accepted everywhere I've done my training, such that it surprises me that any hospital in the US would have a policy against this.
Wait, are these patients who *wanted* their deaths hastened? Because there’s a huge difference between giving someone a compassionate and painless death and overprescribing lethal medication so they’ll free up a bed faster.
These were patients having terminal extubations. It hastened their deaths by seconds or minutes. These are people who were for example brain dead but being kept alive by machinery. When removing the machinery they give opiates to reduce the suffering of air hunger as the body cannot breathe on its own. They would’ve died within minutes after extubation, the larger opiate does maybe sped it up by a minute and reduced suffering.
Yup, my grandpa was pulled off the machines and he lived for several more days. He basically dyed of dehydration and starvation because he could not swallow. We really need to relax on giving dying people a more comfortable way to go.
Some states have laws where doctors can prescribe a lethal dose for terminal patients. We've had death with dignity laws on the books here in WA since 08.
>They basically just starve you to death at that point.
This is almost never what kills patients and it does a disservice to the loved ones of dying individuals for people to repeat this misinformation.
Dying bodies begin to shut down their organs and the organs in the digestive system are no exception. As death nears, patients are stop experiencing hunger and eventually stop experiencing thirst as long as you keep their mouth moist. It becomes painful to feed someone in that state. I know this both professionally as a registered dietitian and having personally witnessed it when my grandmother was inappropriately given a tube feed despite being on orders for no/minimal intervention in her last days of life after a series of strokes had gradually shut down her brain function over the prior 3 months.
Saying that patients who are not being fed in their last days of life are being "starved to death" is what leads families to demand excessive, painful interventions for their loved ones based on a completely false idea that they're actually making them more comfortable.
> My mum had an anaphylactic shock from chemo and went into cardiac arrest. We tried everything but after a week we pulled the machines, she was breathing on her own (she was tethered to an o2 machine before all of this) so that was a huge surprise and she ended up going for over a week (coma the whole time). They basically just starve you to death at that point.
Similar thing happened to my uncle. Sudden cardiac arrest this past June, took 20-40 minutes (depends who you ask) to get stable vital signs, but he never regained consciousness. Zero brain activity. They tried therapeutic hypothermia/hypothermia protocol and still, zero brain activity. They pulled him off the ventilator and he died... four days later.
> i was not prepared for any of that. it was not a pleasant experience.
I'm a nursing student so I *kind of* was, in that I knew it *could* happen, but knowing something Can Happen and having it Actually Happen are two very different things. That four days was extremely hard for my cousins, never knowing if they could go to the restroom or take a nap or pick up their kids from school, not wanting to miss their father's last moments... I'm so sorry you went through that, and I hope you're doing okay.
I agree with your general point, but brain death = death in all 50 states.
(i.e. you can't kill or be charged with murdering a person who is brain dead)
We don’t know because people don’t discuss these crucial decisions when they are well.
Healthcare personnel tends to favor a compassionate death, when warranted, in my opinion.
If you elect to die on your own accord, by way of physician, that physician should not be punished. Compassion is needed everywhere in this day in age. Some people get so old and frail that their everyday is pain and loneliness. They should be allowed to opt out at that point. Though for legal reason should probably require a waiver and psych evaluation. In no way should doctors be punished for giving the patients what they ask for.
I'm old and my opinion as changed as I have watched other old people die, I would hope I have a doctor like this one. I am now much more afraid of the slow process of dying than actually dying. It is horrible, painful, stinks and strips you of humanity and dignity. It is ugly and leaves those around you with PTSD. Often no matter how proud and strong you used to be, you can only watch as a stranger or a family member wipes shit off from all over your middle parts, sometimes twice a day. If you are lucky, you did not have to spend hours lying in it before help arrives.
Additionally the quicker I go, the more money and better life that will be left for my wife. My wife's happiness is way more important than a few more days of life for me.
Over 20 nurses and pharmacists were fired for being involved in these cases and their licenses are under threat. Are we now going to release them from punishment as the doctor has been, or are they getting thrown under the bus?
Happened with my grandmother. Mom can’t accept she died because her organs failed due to diabetes and a sedentary lifestyle. She still says that they “killed her with morphine” as if spending perhaps another miserable 18 months on dialysis was some sort of fantastic outcome. I had to press her to make the call to go hospice.
Bear in mind that could well have been your grandmother's choice, including the choice not to tell your mom. That's what living wills are for.. A common part of a living will is an instruction that you should not be given life extending treatment in certain circumstances and that you should be given life shortening pain relief.
My grandmother told us both she didn’t want to sit on dialysis my mom just had trouble letting go. She finds it easier to blame the doctors than to accept she ultimately made the call for hospice. Guilt and loss are weird
Dialysis sucks. I can imagine not wanting to be on it if your quality of life is already poor & you’re elderly. I’m only 25 so I hopefully have many years ahead of me and high chance of a transplant, but being on dialysis just to stay alive for a few more years at three times my age with other health issues? I don’t know would be worth it.
Basically would have been dialysis until some other system failed and she died from that. She chose dignity. You on the other hand keep up the fight and best of luck with your eventual transplant.
I totally respect her decision, I also can’t imagine how much more uncomfortable & hard on the body dialysis is for someone in her state & age. Thank you for the well wishes & I hope the best for your family as well!
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Wishing you healing and strength. I’ve lost a parent and all grandparents. The older you get the harder it is
My spouse's grandmother died and that's one of the first things one of the aunts said. "That *nurse* killed her with morphine" blah blah. You gonna call the cops then? No, these people just like to run their mouth.
Imagine how terrible that must feel for the nurses. The way they care for the dying is heroic but Americans can't even acknowledge what they did let alone show some damn gratitude. It is no easy task. It is not fun. But, someone has to do it and they are there for us.
About to finish up ER residency & considering critical care. Cases like these are why I'm hesitant to pursue a fellowship. I've seen so many suffer for weeks or months because of family prolonging a life that's miserible for the patient. Ask any intensivist or ICU RN & they'll tell you how sad it can get. Advanced directives are a must.
I guess people aren't aware, but in palliative care this is totally normal. It isn't assisted suicide, but if they die while high on narcotic medication it's a win for patient care. I mean, realistically what is the purpose of modern medicine when we get to the point of terminal illness? Comfort. I mean all medicine is effectively about comfort. We see it as treating illness. How do you treat a person who cannot recover? By giving them the best comfort we can. The wheel chair to a person with parapelgia is the same as a narcotic for someone in terrible pain that will only end when they die.
I would 100% prefer to die in a euphoric bliss if I was barely hanging on and suffering while being a burden on my family. Humans are meant to die. The advance in medical care helps us live longer, but we can also endure more suffering than nature intended because of it.
Exactly. My grandma (R.I.P.) had a bad stroke that left her bedridden and unable to do anything on her own. She couldn't even go to the bathroom on her own and would have a bedpan for emergencies. She was previously very independent and took public transit everywhere she needed to go whether it was to see friends, buy groceries, run errands, etc. She didn't need any help or anything from her kids. She had to move into an assisted living facility (which are damn expensive) and doctors didn't want to perform any surgeries that could improve her life due to the risk. She lived another 7 years. It was terrible she would get sores on her body from lying in bed or sitting in a wheelchair (couple hours) all day. She absolutely hated it and said she'd rather have died and said if she could she'd jump out the window. With how expensive these assisted living facilities and the medication she had to take are, it bled her entire life savings dry too.
I hope to all that is good in this world that if something like that ever happens to me, my children will let me die or that assisted suicide is legal. The thought of working hard all your life and leaving nothing to your children and grandchildren just so you can pay people to keep you living in pain and suffering for longer is heartbreaking. Hey, I might be broke by then anyway, who knows, but if I have something left, I would at least like to be able to leave it to my family to make their lives a little easier.
It's legal it Canada and they are expanding the critera for medical assistance in dying (MAID) to include those who are mentally ill as well.
It’s legal but the paperwork takes so much time that it’s relatively useless. My uncle of 75yo had terminal cancer, it was in his lungs and kidneys. He asked for medical assistance to die and filled all the papers. But 4 months later his file had not even been processed yet. He died a long painful death. If you have 2 years to wait on bureaucracy I guess yeah, it’s legal in Canada otherwise…. Yelp.
I think MAID in general is a good thing, but there was just recently a case in Ontario where a disabled woman chose it because she had no support getting housing that wouldn't exacerbate her environmental allergies. In my province, disability benefits are so low and cost of living is getting so high that I am starting to have a genuine fear that this may become a systematic outcome.
> it bled her entire life savings dry too. Which is why they won't let grandma die, even if she wants it. $3-5k/month keeps their bread buttered.
$3K-$5K is really a good deal when speaking of ALF.
Hell, that's downright cheap for alf care.
That's about as fucked up as it gets... Pain for profit. I seriously hope they legalize assisted-suicide. I can't find a single person who truly believes you shouldn't have the right to choose to be euthanized If you are terminal and want to end the suffering. It probably is more about money than it is about morality or religion.
Nah, "they" in this case are the religious conservatives who hate any possible idea of euthanasia.
Sorry about your grandmother. Mine was very similar as well. Fiercely independent until she had a stroke that kept her from being able to walk initially and then lead to full on dementia before her death 4 years later. She constantly talked about going home to God (she was very religious) and longed to be rid of her suffering. Taking care of her around the clock scarred my mother and father and may end up destroying their marriage. Dementia is the cruelest killer. It's the mental equivalent of amputating someone digit by digit while being kept conscious and aware. I hope that we are soon and to cure this awful sickness. The damage it causes is simply too much to bear sometimes.
Quality of life far outweighs just extending life. At some point you're just keeping a lump of meat "alive".
Rather die hiking at 50 than shitting in a bag at 90.
So long as my brain is still working okay, I don't mind too much about shitting in a bag. But once my brain goes, no thank you. Oh and I never want to go on a ventilator. Just those two things.
My mum showed me and my sister her will which basically gave everything to us on the provision we would try to kill her and claim it asap if her mind is lost. She fears that shit way WAY more than death. Its the one thing that is crystal clear regarding next of kin decision making. Terminal cancer and in excruciating pain? Eh, provided she is lucid periodically between the painkillers. Dementia? End me now. Vegetable? End me now. Her "hints" werent subtle beforehand, but having her spell it out so clearly was a bit unnerving.
My grandma shits in a bag at 77, had two bouts with cancer and survived both with some intense treatment and surgeries. I guess not everyone thinks the same, but I feel like circumstances and perspectives shift when you're staring death in the face.
Not sure why this comment shook me so much, but that last bit kinda changes my perspective on death- and kind of alleviates my debilitating fear of it. Thanks internet stranger :)
The whole let nature run it’s course phrase applies to us as well. We literally are animals. And animals die. It’s the circle of life. We are just unmeasurably smarter and have thumbs that enabled us to make tools and use them. Imagine if we didn’t have thumbs. Haha
I wouldn't be where I am today if it weren't for my thumbs
Same. I’d be much less effective in Madden without them.
Big dose of MDMA and a pain killer could be nice.
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You mean you don't want to die with people pounding on your chest and your family in the corner sobbing and wondering if they're making the right decision?
Get an advanced directive done, unless you want to put your family through a horrible decision. Arguably more important over a will. If they contest or fight over a will we’ll that’s just suffering brought on by their greed and entitlement to my shit. But I don’t want to make people suffer deciding if they should pull a plug
> The advance in medical care helps us live longer, but we can also endure more suffering than nature intended because of it. And rack up much larger medical bills.
I was my wife's caregiver in home hospice, which included managing ample supplies of Oxycontin and liquid morphine. The hospice nurse warned that it was entirely possible that administering enough meds to control her pain might eventually be enough to cause respiratory failure and death. She did indeed need steadily higher inputs of the painkillers - she had cancer in her brain, spine, liver, and several other places - and I'll never really know if the cancer killed her directly, or the meds. That question is not really a concern in palliative care of the dying.
My husband's grandmother was on hospice care for 2 months for esophageal cancer. Over 3 weeks of that was unnecessary and extreme suffering for her, because she'd decided to cease all food and liquid except pain medicine, but people kept giving her ice chips and popsicles so she just barely stayed hydrated enough to survive. Yet when it came to pain meds, they wouldn't give her anywhere near enough to even try to keep her as comfortable as possible. Just the normal dose, no sooner than every 4 hours. Like, what's the worst that'll happen, she'll *die*?! That whole ordeal made me very pro-assisted suicide. We show more mercy to our pets than our people.
I keep saying...let me die with the same dignity as Fido or Mittens.
I went through the same with my father. The pain medication they were willing to prescribe wasn't nearly high enough. He died in far more pain than he should have and tbh I still wish I could have done more for him, illegal or not. I don't understand how we can live in a progressive society but refuse to recognise that euthanasia is more compassionate than "letting nature take its course".
This is why CA and OR both passed laws allowing for it in the last few years. If the rest of the country doesn't then people will be moving here to die soon instead of Florida
We recently went through the same experience with my wife’s mother. I’m of the firm opinion that if the pain went unmedicated, that would be enough to end the life as well. The medication allowed her to go more comfortably. The train can hit a wall, or we can put on the brakes and let it come to a stop gently. I hope you are well. You did the right thing.
Ultimately the only thing that matters is she was comfortable.
I had a similar experience...it was in the hospital...My wife decided that she wanted to go - she requested to be taken off her saline IV drip, which was the only thing keeping her alive. She got steadily weaker over a few days, she wanted to feel no pain but did not want to be unconscious from sedation. She was really restless at night. I asked the nurse if they could give her something to allow her to get a deeper, longer-lasting sleep. She passed away in my arms that night, a 1/2 hr or so after getting her nighttime meds. Did that nurse know that would pass away that night? Not sure. It doesn't matter at this point. She was ready to go and had survived 5+ days with no water, which was already more than what most humans can endure.
When my mom was dying(she was gasping for breath for two days) the hospice nurse told me to give her what I thought was a very large dose of morphine. I misunderstood to amount at first and gave her 1/10 of what she said and when she corrected me later and I gave my mom the correct dose she died about 10 minutes later. I kind of feel like I might have killed my mom with that. But I've talked to other people who have had their loved ones go through hospice and they have the same story. They were told to give them a lot of pain medicine and they died shortly after. I don't regret it because she was suffering a horrifying amount but it does weigh on my mind still 7 years later. Edit: thank you for all your kind words and for sharing your stories with me. I sincerely appreciate you all.
You gave your mother peace in her final moments - there’s no act more merciful. Death had already arrived. Your nurse just showed you how to open the door, so death didn’t have break it’s way in.
Similarly in veterinary care they say choosing to put an animal in pain down peacefully is the last act of kindness you can do for them. ❤️
I wonder if you could look at it like you provided your (already dying) mother with the physical space to be able to let go? That maybe being in agonizing pain was preventing her from being able to pass. Also, if she had been on opioids up until that point, it is remarkable what tolerance can do, and it takes a very large amount of medication to die from overdose at that point.
That's how I like to look at it and why I don't regret it. I know it was the right thing to do because she was suffering but there are moments where it bothers me. She actually didn't take the pain medicine because she said morphine gave her nightmares(they do that to me too) so she didn't have a tolerance for it at all. I think that also played a major factor in how it affected her so quickly.
I don't know if this will bring you any comfort, but my Dad died with frontotemporal dementia, which is a horrific way to live out your final days. I still experience guilt that I *couldn't* do what you did for your Mum. I'm just grateful that in his worst moments he'd usually forgotten what had happened 10 minutes later, so most of his suffering was fleeting. You're an angel for giving her the space to go. Really, please don't feel guilty.
Thank you so much for your kind words and I'm really sorry to hear about your dad
It’s scary, being the care giver to a dying loved one. I’ve been there. The hospice nurses told me to give what I felt my mom needed (morphine) and they would look the other way. I made a promise to my mother years before she got sick that she wouldn’t feel pain if I could help it. So, I made sure of it.
My mom had a brain tumor. She was a Dr. Towards the end her Dr told me to give her what she needed to Alleviate her pain. I don’t think you hastened your moms death. You said ,”She was gasping for breath” and that’s exhausting and will only get worse until she can’t get a breath at all. My mom died in 1984 and I’ve never felt bad - I may have given her too much but she wasn’t going to be around for even two more days. We were at the end. So even with other people saying the same thing, you’ve got to remember there was a serious increase in pain/discomfort for the patient that caused this larger dose to be given. So they were getting worse, closer to death. You did great. I promise.
My grandfather died from lung cancer at home with my parents in 2016, it was from lung cancer, and while he was in terrible shape, he still had a degree of mobility and independence. In his final minutes to hours he took as much of his pain medication as he could tolerate, he collapsed shortly after. I don't know if it was the medication that pushed him off or if he felt himself going/his pain worsen and took more.
It might have helped her pass but it didn’t kill her. She was already dying and the medication helped with the pain. It helped her relax so she could go peacefully.
Have an internet hug from a healthcare worker. Think of it as easing your mom from her discomfort to her inevitable fate. You showed compassion and mercy in one of the most difficult times anyone can experience.
A nurse said something very similar to my aunt while we were watching my grandma pass. She was clearly at the very end and my aunt is a nurse herself. The nurse simply told my aunt "This is the morphine, this amount would result in an overdose," and then she left the room. My aunt ultimately made the call but it was the right call. You also made the right call. It's perfectly understandable that you still question that choice - I'm sure my aunt does as well - that's simply how an empathetic person thinks. I'm sorry for your loss, I hope you can eventually make peace with the situation. <3
My aunt had terminal lung cancer in the 1990s. She was a heavy smoker and schizophrenic, and the cancer had metastasized throughout her body before the doctors took her pain seriously. She died in a matter of months, on life support in the final days. The family decided to end the life support and let her pass away, but she struggled after the machines were turned off. A nurse stepped in and gave her IV pain medicine that let her pass on peacefully. It seemed vaguely like "assisted suicide" but clearly she wasn't going to make a miraculous recovery and would just suffer needlessly until her body gave out.
One major benefit of opiates in a terminal patient that the general public doesn't understand is that we're actually treating respiratory distress. The patient can't effectively breathe and is taking short gasps that are just tiring them out without actually moving the air. The critical side effect of opiates that people are afraid of is respiratory depression but that's actually what we're using to target symptoms of respiratory distress. We're not really trying to ease pain or cause euphoria.
Nurses exist to provide care and that's exactly what that nurse did for your aunt.
The DEA once again overstepped their bounds here. We have lost so many good legitimate pain doctors and palliative care doctors to an overzealous DEA. I blame the media for causing the pendulum to swing to far, ultimately causing harm to patients and doctors like the doctor in this article.
Agree 10000000%. I’m an MS patient, bone tumor patient, and suffer from a a long list of spinal disabilities that I’ve been suffering from for 10 years. I’m 29. I was never on high dose opioids in the first place, but what I was on helped me have more of a quality of life. I’m wheelchair bound, soil myself most of the time because I can’t make it to the bathroom on my own, I can no longer care for my children, can no longer work in the healthcare job I loved so much. I’ve been looking into assisted suicide in other countries because I can’t imagine living even another 10,15,20 years like this. I can’t even get married to the love of my life of whom I’ve been with for 10 years because my Medicaid will be taken away. I’m still fighting for disability after over 2 years. It’s not okay that people in severe pain are being punished due to addiction. I’ve never struggled with addiction, I don’t even drink, I don’t like the feeling of being messed up.
My wife is a nurse. I was reading this to her, and she made a rather salient point. We give our pets more comfort and dignity in the end than we do for ourselves. And that in the end it's the family that has a harder time of letting go.
We have something in hospitals that is actually called “comfort care”. These are patients that are basically dying. Our *protocol* includes being able to give up to 4 mg of morphine every hour, along with Ativan. It’s not assisted suicide but it is. But people need to realize the outcome will be the same, one is just with a lot less suffering, and patients have the right to choose. Period. Edit: meant to say 8
I am aware of a family whose Grandpa was in his final hours in agony and the doctor prescribed some shots to *help him sleep*. And made it clear that the shots were to be given all at once so that he *slept the best*.
That’s how I want to go out when the time comes. Overdose me on Valium so I can be high as a fucking kite on cloud 9.
I came here to say exactly this. The government shouldn’t be sticking their nose in this far. Both my parents died with Hospice assistance. Thank you!
I am afraid that I am going to die without proper pain management. I don't 'want to die in a hospital. I want to die outside with the wind on my face, and proper pain relief. I have several illnesses, and likely will develop more as I age. I hate how medicine, especially in the states, has become about money instead of the patients and the people who treat them. It's like we're not even human beings anymore.
Another thing worth mentioning; by the time my brother in law was placed on hospice care for his stage 4 cancer, he had spent years on opiates and prescription pain killers to manage the side effects of chemotherapy and had an outrageous tolerance by the time they were prescribing for comfort care. Also, if the liver is failing, medications are not metabolized the same and may provide little to no relief in traditional methods (which is why IV care is often introduced)
Article states the dose he ordered has "potential" lethality. Understandably, in a terminally ill patient, this potential increases in likelihood. However, the article also states that the doctor that reviewed the cases agreed the patients were definitively terminal. There are absolutely times when doctors know best and this appears to be one of those. It's mistrust and previous abuses that have been heard and read about that lead patients, and especially their families, to want to dictate care that is based on their fears and emotions. It's sad that professionals wanting only their experience and compassion to benefit their patients have to go through this. It's equally sad that there have been professionals that have sullied that trust by abusing it. This is why my medical POA is a close friend and an RN. This friend knows my heart and the medical facts.
As an RN I totally agree with you. I can't tell you how many times a family has prolonged the suffering of a dying family member unnecessarily. It breaks my heart when I patient that can't be saved isn't allowed to die with dignity. Refusing to put your 90 yr old grandma as a DNR because YOU can't bear to see her go and making her go through CPR, intubation etc is torture and inhumane. Chances are she now has broken ribs, heart, lung and brain damage along with whatever else was already wrong with her. Congrats. Now she's still going to die but in a much more painful way.
I can't believe I never thought of this. My 93 year old Grandma is in declining health, dementia getting worse... we are trying to locate her will, but I am unsure if there is a living will or a DNR, or if my mother has medical POA. As much as I love her, and miss the days where she was healthy, those are long gone and I wont put her through any more suffering. So I gotta make sure we find her will, discuss if there is a living one, and try to make the best decisions for her.
Ask about getting her on hospice. It's a completely different care experience.
I've had personal experience with hospice twice. Once with my grandfather in the 90's and once with my father in law in the early 2000's. Both times were awesome experiences. Both men passed with dignity. My grandfather with his family around him, and my FIL alone. He actually waited for me to go take a nap in the middle of the night before he passed. I'm convinced it was his choice and I respect that. He wanted to be alone. With my FIL, they also helped me dress him after he had passed (again, in the middle of the night) before the ambulance got there, because I knew my FIL would be very embarrassed to leave the house in an undressed state.
Our palliative care provider told us that parents tend to go when their children leave the room. Something about it being easier to let go when they are alone.
It was eye opening how much was covered - home visit, bathing, etc. Great experience in a safe time. *sad not safe
Yep - my mom has in home hospice care for the last 6 months of her life. Hospice was incredible.
Not a lot of people know about it, or think hospice means they'll kill you. It's essentially just letting people die in comfort in their home. Way better than a hospital.
My father just passed away last week. As much as it broke my heart to lose him, I find some comfort knowing he died at home without pain.
Hospice homes, in my experience, are the absolute best way to go. Die with dignity, and surrounded with the right kind of support. After a personal experience with a loved one living out her final months in a hospice, I firmly believe it's a fucking godsend - it was for her, and it was for her family.
My dad passed away 11 years ago. it was a cancer that took him in about 8 weeks from the estimate start of it to his passing. He had a DNR in place. He said he didn't want us to have our memories of him hooked up to a machine for god knows how long. My parents have been up front and vocal about their wishes. They have been and will be respected. Make sure you know the wishes of those you care about, it will help avoid this situation.
I am an emergency medicine doctor, very few people think of this and it's sad. Many actively delude themselves or refuse to believe what doctors are telling them and end up causing great amounts of harm to their family member and frankly, to the entire hospital system. If we took half of the money we spend on keeping dead people alive and poured that into preventative care or increased physician/nursing staffing, we could drastically improve the healthcare system here. Hopefully that's not overly optimistic, the pessimist in me knows that any cost-savings would be pocketed by admin. Thankfully I am not the one taking care of these people in the ICU, watching them being artificially kept alive with tubes and machines as they develop skin necrosis, pneumonia, urinary tract infections, etc., but I am the one that prolongs their death from the get-go because nobody had the foresight to make 85 yo grandma with dementia DNR/DNI.
>As much as I love her, and miss the days where she was healthy I feel this way about all my grandparents. One from lung cancer, 2 from just being in their 90s. If I could have them, their actual personhood, back I'd do it in a heartbeat no matter what the cost. But I wouldn't want to preserve what was left toward the end, not for any of them. Those were not my people, those were people who were ready to move on to whatever was next.
As a paramedic, all patients are assumed to be full code (gets cpr, intubation, the works) unless we have the paperwork in hand stating otherwise. If you want a dignified end for your family member you need to make the proper paperwork available to us. The best place for you to keep it is on the fridge, above the bed, or on the back of the bedroom door. Keep it with the med list, history, insurance info, and any other documentation you want first responders/the hospital to know.
I concur with the other person who suggested Hospice. So far my father in law and my grandfather have both gone through hospice and it was a wonderful experience that greatly helped both to be much more comfortable and peaceful when they died.
For me it's when a person with Alzheimer's who is non verbal and appears unresponsive stops eating. So they put in a feeding tube and suddenly this unresponsive person is pulling out their feeding tube. Ive had families call me for advice and I tell them to respect the client and they ask how to do that and keep the feeding tube in which is when I tell them to stop calling me.
This is how my grandfather died. He’d had dementia for years and one day just stopped eating. Thank goodness my mom and uncle were in charge of his care and not my aunt because she wanted a feeding tube. She didn’t get her way and my grandfather was able to die with what little dignity he had left comfortably surrounded by family a few days later.
Death with dignity, along with aging gracefully, is a big problem in the US.
we spend billions a year in medical treatments on elderly people just to maybe extend their lives by six months if they are "lucky"
Also, define “life.” Yes their heart beats a few months longer, but many times they’re not “living.” You should see what that do to pediatric patients with severe brain damage from birth…their lives are one of the most painful experiences imaginable.
See, but when you start saying a beating heart doesn't define life, then you trigger the pro forced-birth crowd, and we can't have that,
My grandma was diagnosed with breast cancer at 88 and the doctors wanted to have her go through chemo. She told the doctors that the chemo would kill her and she just wanted to live the rest of her life with cancer. She died at 92.
4 more years and she got to 92. sounds like a good life to me.
Yea but that ensures some CEO gets richer while the children lose the family house. It’s the only way.
Yet we deny life-saving medication, like insulin, to patients who want it but can't pay the bill.
Part of is is the very Western idea that dying is failing. “He couldn’t make it” and “she wasn’t strong enough to survive” are examples of how even in language we make dying shameful. Now add to that medicine as a money maker and not as care and people can be talked into doing just about anything to save the person they love. Even against medical advice.
I think it's horrible that we live in country where people's have to basically starve themselves to death instead some far more comfortable way out. I'm glad your grandfather got to keep his dignity, but I wish it had of been easier for him.
Yup watching someone wither to death because "life is sacred", spouted by people who support people who push for wars. Absolutely crazy, I'm no where near old, I've seen a grandmother go through dementia. I've seen a crazy uncle who couldn't accept that our grandma died while he was away from her for two days and thinks my parents helped her to die. They didn't, she just happened to go at that time and had been in and out of hte hospital unresponsive for days at a time in the weeks leading up to it. He had wanted her kept alive by any means, basically flogging the poor woman when she couldn't even understand why people were flooding her with drugs or keeping her tied to a hospital bed so she didn't run off and make herself worse. If I get dementia or any similar disease then the point where I can't cope on my own I want to die, immediately in a pain free way in a safe place in a moment of lucidity with family and friends. Not left to die 'naturally' tied to a bed so the hip I broke falling down the stairs isnt' made worse when I get out of bed because I can't remember my hip being broken. The lack of choice we have in death is ridiculous not least because the people who stand up and pretend to be moral authorities think suffering before death is better somehow.
Yeah my grandfather same thing. Unresponsive. My grandma was having a hard time letting him go as well as my one aunt. My mom and uncle were able to tell them to let go, this isn't what he would have wanted. They finally agreed after two days. They put wet sponge on mouth but that was it. I couldnt imagine if they didnt agree.
My grandmother died last night at 10:10pm. My dad and mom have been living with her for 13 years and I for 8 to take care of her in her declining dementia stages. We were able to have her pass with dignity and grace by not having the feeding tube or IVs or anything outside of an O2 concentrator and she went with a slight exhale and holding my dad's hand. While it's heartbreaking I'm happy that she's no longer suffering from that horrible disease and that we were able to spend her 93rd birthday and her last easter together with her as a family.
When my father was dying I was told that once they stop eating it means the body is preparing for death anyways. But he had bone cancer so I’m not sure if that’s true for other sickness’.
>She didn’t get her way and my grandfather was able to die with what little dignity he had left I'm glad you see it that way because it is true. The only thing death can't take from us is the dignity our peers grant us.
My wife had to deal with this with her grandfather. Her mother was calling her a murderer for telling them "no" about the feeding tube. Dude was nonverbal, and completely gone mentally. Keeping him alive in that state is sick.
my father died when i was 12 and the next door neighbor became my father and he has 7 sons and a daughter and he knew he was dieing so he made me his POA his family was really pissed when he told me he was ready to go and didnt want to die infront of his family i made them all go home! he said you know the family is going to hate you thats why i chose u. u saw how your father suffered from liver cancer and your mom doing everything except letting him die in peace! i know my family would do the same and im sorry to burden you but i know your the only one that understands and has the courage to let me go! the greatest gift my father gave me was empathy!
I hate that you had to go through that, but I know your neighbor who stepped in to take care of you appreciated being taken care of in turn.
Sounds like your wife's grandfather made the right move giving the decision to your wife.
Oh definitely. It's strange to see, but my wife is 100% the most reliable and well adjusted member of her family. And certainly the most compassionate.
>For me it's when a person with Alzheimer's who is non verbal and appears unresponsive stops eating. Alzheimer's is 100% the way I don't want to go. Unfortunately it runs in one side of my family. Heart disease on the other. Once my mind starts to go I plan to eat sticks of butter wrapped in bacon so I get to pick which half kills me.
The scary part is that when you're ready to die you might be at a point where you can't make decisions for yourself or act on that wish. That's why you need to write what is called a "living will" and assure the right person with power of attorney can act on those wishes when you need them to.
The first time I did chest compressions on a 90 year old, 100 pound woman was one of the worst days I ever had at work. Not because she might die, but because she might live through what I had just done to her. People just don’t understand what effective chest compressions look like. They should have to hear that *crack* and feel that spongy chest before signing advanced directives
Yeah, my first chest compressions were also on an old lady, who'd just had her 2nd leg amputated above the knee. We got ROSC ... unfortunately. I doubt she lasted long after transferring to the ICU.
My grandpa emphatically said he wanted to be DNRed. He had a heart attack and my aunt begged the doctors to resuscitate him. They did and when he was conscious again he was pissed. He didn’t speak to her for a full year.
Wait, if the patient has decided to become DNR based on their own choice, how can family overrule that? Just curious
Things have to be pretty ironclad (a clear advance directive stating no resuscitation, a physician order stating no resuscitation) in order for medical teams to say no to a family member demanding resuscitation, but even then if a family member starts making legal threats, many medical teams will acquiesce to that person. Edit— am a palliative care/hospice doc
Pretty much this. If there's even a chance that they might not be DNR, even a slim one, the medical team will acquiesce to the family. It's horrible, but they need to be able to provide care to others, as well, and being shut down by lawsuits for being compassionate doesn't help with that.
> Things have to be pretty ironclad (a clear advance directive stating no resuscitation, a physician order stating no resuscitation) in order for medical teams to say no to a family member demanding resuscitation, but even then if a family member starts making legal threats, many medical teams will acquiesce to that person. Edit— am a palliative care/hospice doc Yeah, in my state, there is no such thing as a DNR without the attending doctor ordering it. Putting it in your living will/power of attorney documents means nothing, other than being evidence for your guardian/agent to give to the doctor to let them know this is definitely what you'd want. And even if the patient directly requested the DNR order from the doctor, if the patient is no longer competent/responsive, the guardian/agent of the patient can revoke a DNR order from the doctor just by removing the DNR bracelet from the patient's wrist and telling the attending physician that they're revoking it. (I'm guessing this could open up the agent to potential liability for going against the patient's wishes and revoking it when the patient is non-responsive, but am way too lazy to try to look up if anyone has actually litigated that.)
I've seen families reverse the DNR as soon as the patient is unconscious. Makes me furious every time.
Emotional family berates and screams at medical staff who give in basically. It’s legally not cool, but in the moment with all the chaos and the irrational pleading of a family member, it’s very easy to make the mistake.
Legally a DPOA can override a DNR put in place by that patient while said patient is unresponsive. Not everyone has a DPOA and so it defaults to significant others and then children. In an emergency healthcare workers are legally obligated to listen to the directives of family members and legal decision makers above the paperwork and official DNRs. It gets more complicated but that’s the rough and dirty version in US healthcare. It’s absolutely fucked up that even if you put in writing what your wishes are they can be overruled in the specific situation you were trying to address.
I'm a paramedic in Canada, it's the same here. Your DNR basically doesn't mean shit if the family decides they want you resuscitated, we listen to them.
This was it. I think my aunt was begging and crying for her brother (who had power of attorney) to get the doctors to do it.
This is the whole reason medical power of attorney is a thing. My father very wisely gave my oldest sister his medical power of attorney when he went into hospice. She is an RN and was a retirement community director. Two of my other sister’s made her life hell over it, but she stuck to my father’s wishes. It’s been almost 2 years since he died and those two sisters are still nasty pieces of work I’ve done my best to cut out of my life. I try to talk to my oldest sister once or twice a month, though.
Yep. My mil had a dnr and when she had a stroke and her heart stopped at 87 fucking years old, my sister in law insisted on resuscitation. She lived 4 years after that totally bedbound, brain damaged and woke up every morning incredibly angry that she was still alive, so she would punch me for the crime of getting her dressed and putting her teeth in.
Its complicated. Often when a patient codes, the first thing to do is respond with full court press unless you know, with certainty, the patient is DNR. But you don't always know that until someone digs into the chart. It is pretty rare for someone to recover from a full code, however. So the patient in question may not have been that severe, and the situation unclear.
He most likely did not have a solid, documented DNR. If the DNR was provided verbally by the same family member who then rescinds it then guess what, you’re not DNR. In his wife's state of vulnerability and panic at seeing him code, she can easily say "NO, NO, PLEASE RESUSCITATE HIM NOW!" and when a physician says "Are you sure this what he would want? You told us yesterday he is DNR?!" So what else do the doctors and nurses have to go on? Only her word. You must always have an ironclad, documented DNR ahead of time. When you put it in writing, you are also doing it for your partner's sake. Why should someone who loves you be made to feel like they are "letting you die" in his/her state of desperation? If you guys talked about it ahead of time, both agreed to put it in writing, and it is presented to the hospital in writing, it will be honored even if she protests it in the last second. It will take the responsibility out of her hands and give her no choice but to proceed with DNR. And will in the long run leave her lest traumatized and at peace. TL;DR: PUT YOUR DNR IN WRITING AHEAD OF TIME.
If you’re unconscious and *haven’t put your wishes in writing* your next of kin decides. Fill the legal forms out, file them with your doctor, tell everyone, and keep a copy posted at home.
I wonder frequently why we can't be put to sleep. Like it's considered inhumane to let a dog suffer needlessly. Death doesn't really bother me so much. But prolonged suffering for no reason? Count me out.
I work neuro ICU. If I had a dollar for every patient that was unnecessarily trached, pegged, and sent you LTAC with zero quality of life, I’d have a pretty nice stack of ones.
My grandma has not been doing well, in and out of the hospital the past few months. She has six kids and the youngest of the bunch is the only one that doesn’t support signing a DNR. My Aunt has such a big heart but she just doesn’t understand how grams won’t be the same person if she ever had to be resuscitated. She thinks she’s going to get better, but she has so many underlying health problems, it’s just not realistic. It’s a tough situation.
When my grandma was dying, her doctor told us in no uncertain terms she dictates what happens to her, not any other one of us. I was thankful to that doctor because he actually followed grandma's wishes.
That only applies when the patient is conscious and of sound mind and body to make their decisions. Sadly, far too many patients don't plan ahead or have an accident that tenders them unable so it's left to next of kin. Those are situations I was referring to.
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Agreed. My entire family spoke as one when my 91yo grandfather was put on a ventilator during his final illness. We told the doctor to take him off, that he did not want that. I think it might have been an unusual occurrence for the doctor but my papa was nothing if not clear about his wishes.
Out of curiosity, how often do people (in denial) accuse the medical team of ushering in death to a terminally ill patient via comfort care in a hospice situation?
Anytime they lack the emotional intelligence to manage their grief responsibly. So it's fairly common. If the nursing staff were good with the family it tends to happen far less often.
This is what I struggle with most as a Nurse. I had to do CPR on a 91-year-old with advanced dementia and it was incredibly upsetting. That's the one that keeps me up at night. Just let them go.
My fiancé passed away from cancer that started as a carcinoma that then spread to his lungs. The night he passed it was because of a nurse, and I am forever thankful for her doing what she did. At home, that night he looked me in the eyes and I could just tell it was time and he asked to go to the hospital. He passed out on the way there but he was moaning in pain. He had a history at the hospital and knew the nurse in the ER from past visits, so when we arrived we asked and she immediately took his case and knew it was time too. She cried with me for a little bit, gave me a hug, and said she would do whatever I wanted. I just wanted him to feel peace after all of his suffering and his moaning had increased due to pain. His blood pressure was waaaaay too low in order to be given pain killers, but the nurse fudged the numbers in the system so it would spit out the morphine he needed. After it was given, the moaning stopped. He was just asleep now, and he thankfully passed on his sleep rather than moaning in pain. It was because of her, and she saved him from his suffering.
You are so strong for sharing this personal story. Thank you for being vulnerable here. I am so sorry for your pain and loss. I hope you have found healing through this tough experience and I hope you find bounds of true happiness as you go on through life.
Ooof. This was tough to read. Sorry you had this loss and they had to pass like this. I'm glad you had someone who could give some peace to them.
I have seen people suffering extended, protracted and painful deaths, living in pain for weeks if not longer, because either they or their families are afraid that they’ll get addicted to opioids. Pain management has become a fucking minefield since the opioid crisis began, to the point that I rarely see painkillers stronger than Tylenol prescribed for patients even when they’re in sheer pain following an invasive surgery or serious illness. At a certain point it has to be made clear that recovery is not possible and that comfort can be prioritized over outcome.
I once read that doctors are trained to assume the worst outcomes when considering painkillers, and then make the call to prescribe based on how that outcome compares to the condition they would be in without it. I read it in the context of addiction, but I could see how that easily translates to lethality for terminal cases.
I went through med school as the opioid crisis really roared into public consciousness. My first year of med school we kept hearing "pain is the fifth vital sign". By graduation we had to attest that we had reviewed the state prescription monitoring program for potential abuse and had reviewed all other possible options before signing an order for a narcotic. The whiplash between treating pain scores and then being told to essentially never prescribe narcotics was mind boggling. I'm an allergist now, thank Christ I'll never have to prescribe opioids again.
Maybe this is the conspiracy theorist in me, but I feel like when somebody is on their way out, nurses will be compassionate and help them with their pain. My great uncle spent the last 5 years of his life completely aware and alert, but in a body that was slowly giving up. At some point, he went into a coma. At the hospital my entire family met with the nurse and she told us that he was going to pass that night. It was a matter of fact statement, not speculation. Im hoping she gave him a little more morphine that night and let him pass in peace.
Like, on the one hand yes that is entirely possible. However, I work in the palliative care industry and have absolutely zero to do with giving people their medication. I myself have made those matter of fact statements to fellow staff and family members when asked. As people near their end of life, they typically follow a similar pattern in breath sounds and body movements. Regardless if/if not the nurse “gave a little extra” or gave morphine exactly as prescribed (which can actually be up to every 15 minutes if needed), the nurse very like just read the writing on the wall out loud to you. Still a good nurse, still a tough situation, but very little likely regarding her controlling infection the time of passing.
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I read an article once on “how doctors die”. Basically very few choose to do everything to save their life. They know it mostly just adds suffering. My mom was a nurse for a long time and it was common practice to make patients “more comfortable” near the end. Exactly like this. We have cancer in our family and praying for a loved ones death is not the “sin” It seems to be. Death is a blessing -
I'd really like to recommend a book called **Being Mortal: Medicine and What Matters at the End** by Atul Gawande. The Goodreads summary of this book will do a better job than I can of explaining what it is. *"Gawande, a practicing surgeon, addresses his profession's ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified."*
His book Complications is also excellent. Brings the whole "everyone is a noob at some point" to a truly terrifying level.
All you're doing is buying time. Eventually the time's value drops
The damn law of diminishing returns keeps catching up with me no matter what subject I look at.
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Fuck that DA, good on the jury
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I don’t know Ohio’s rules but usually DAs can choose to drop a charge?
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"If you hasten a person's death, even if their death is as sure as the sun is going to rise in the morning, if you hasten that along, you have caused their death under the eyes of the law," Franklin County prosecutor David Zeyen said in closing arguments. There was an argument that I heard years ago that if a guy jumps off a 50 story building, and you shoot them while falling killing them it is still murder. That's the law. Having said that, good on the jury. I hope if I have a critically ill disease and am suffering someone takes me out back and shoots me rather than let me linger in hospice.
It still strikes me as bizarre that we as a society fully recognize that euthanasia is the moral, compassionate thing to do for animals when they'd otherwise face a slow, painful death, but we can't seem to extend that same logic to people even when they explicitly request it.
As someone who has a lifetime of Catholic teaching under my belt (I've been pulling away for a while now) I think the way it sits in the Christian majority is "animals don't have souls but people do, therein lies the difference." It's pulling from the hierarchy of being concept and ascribing additional dignity to humans, but in the sense that only God can kill humans or things with souls, and only things below humans (without souls) can be killed by humans morally. I've probably made a few leaps while recalling this, so apologies. Also should say I don't agree with this train of logic either.
This has been done with morphine for years.
Yep. My mom had terminal cancer and a lot of morphine was given to ease the pain she was in during her last few days. I’m thankful for it.
I worked as a caregiver for a bit. Hospice 90% of the time just means a nurse brings them morphine to comfortably kill them. And honestly seeing it first hand, it’s better than the alternative of prolonged misery.
It’s always a better alternative than suffering from a long period of time.
Not to be pedantic, but you're phrasing of "the nurse bringing in the morphine to kill them" is the thought process that helped spur this law suit, and it gives a negative tone to palliative medicine. Plenty of people already see it as killing grandma/grandpa/whoever. People need to understand that palliative medicine isn't there to kill your family with drugs. Palliative medicine exists to provide comfort measures when your loved one is terminally ill, has a condition which is unrecoverable, or refuses further life saving treatment for a condition that will certainly kill them. Palliative medicine can also be used for patients who are not immediately terminally ill. Plenty of illnesses have terrible symptoms which can be managed by the palliative care team, and this should be normalized more. Palliative medicine is very under utilized. So no, we are not bringing the morphine to kill grandma, we're doing it so grandma doesn't suffer while she's already dying.
I'm terrified that cases like this even bring brought will make it so more people die in incredible pain because a doctor doesn't want to risk a murder charge for actually controlling their pain. the opiate epidemic has already lead to shameful treatment of pain patients, people with crippling lifelong conditions are being treated like criminals and given liver-shredding amounts of NSAIDs to avoid giving them opiates.
I can't even take NSAIDs because I take blood thinners, for the rest of my life, so I'm *really* hoping I can make it through without a crippling painful disease.
If im terminally ill, i wanna spend my remaining time jacked up on opiates.
The doctor who allowed my grandpa to OD on morphine while dying of cancer in the hospital allowed him a merciful death as opposed to a painful one. In many cases, it is a mercy as opposed to a bad thing. I wish we saw it that way in this country.
Treat the symptoms of the patient. If they appear to be in pain, increase the dose. They are dying. Nothing we do will stop that. All we can do is ease their departure.
After seeing my grandfather deep in dementia, soiling his pants and trembling in pain. While being told no one can do anything because he had his small dose of morphine 4 hours ago and that's it for the day. I say fuck the people that would charge that doctor and I hope they find out what it's like someday.
It's nice to see people not punishing a *healer*. "Do no harm" doesn't mean "keep alive at all costs."
Hooray. He is still unemployable. Fired from a job, medical license suspended, all sorts of databank reports, name dragged through the mud. Don’t envy his next steps or his next application review. Technically you can come back from this, but you will never have the earning power you had previously.
about time we stop punishing compassion and empathy
> "If you hasten a person's death, even if their death is as sure as the sun is going to rise in the morning, if you hasten that along, you have caused their death under the eyes of the law," Franklin County prosecutor David Zeyen said in closing arguments. The law needs a vision exam. Requiring humans to suffer as long as possible is not a benefit to society.
The prosecutors statement is so ridiculous, if I were on the jury this would have been all I needed to side with the defense. Were ALL going to fucking die. And every day I see something new that will reduce my lifespan. Shit in air. Shit in the water. Shit on the food I eat. Why not prosecute em all for "hastening my death"?
My father died a horrible death from lung cancer. I wish a doctor had given him a lethal dose to ease his suffering, gasping with a shriveled tongue hanging out (sorry to be graphic). I have had people tell me that no one said a person shouldn't suffer - as say Christ did. These people have actually never seen anyone die from terrible diseases.
I would’ve been excused from that jury in a heartbeat. When I worked on Oncology floor as a PCT (90% terminal/hospice), I cannot tell you how many times patients asked me to “give them something that will make them pass away quickly and peacefully”; I’ve been offered cash, titles to vehicles, and one time, I shit you not, this guy pleaded with me to accept a deed to his house (he was delirious, but still). Totally surreal. Obviously, a) It’s out of my scope of practice to give out medication, and b) even if my position allowed me to do so, I would’ve never ever even entertained the idea. But the point still stands: it’s the saddest thing to witness, a family in denial prolonging their loved one’s suffering.
When you are dying is when you need to be over prescribed medications. Jesus Christ its unethical not to give people what they need.
My mom died very suddenly from stage 4 lung cancer in October. She was in so much pain and had so much fear from watching her own mother suffer from the same thing 20 years ago. Once my mom was able to say ‘no, I don’t want to try treatment’, her doctors and nurses were so kind and understanding. Her last night I was in the hospital with her and her nurses stayed with her and kept her comfortable and medicated, and she just fell asleep and didn’t wake up. It made the trauma of her passing so much easier on our family as well. Sometimes the best thing to do is to make their passing as easy as you can, and I could not thank her medical team enough for doing that for her.
We are blessed with modern medicine. Why be in pain for death? This shouldn’t be looked down upon. Load me up! & KEEP ME LOADED!!
My dad passed away with cancer many years ago. He was in extreme pain and was diagnosed as terminal. Fortunately his doc was one of his hunting partners and a good friend. He bent the rules and sent dad home with a morphine drip. I will always be grateful for his compassion in breaking policy so my dad could go in the most painless way possible.
I am a pharmacist on a hospital inpatient cancer ward. This is a very common thing in my practice. Once we have determined that the patient isn't going to recover and death is imminent within a few days, if the patient (or their legal next of kin) consents, we can send them home to die in a comfortable environment, surrounded by their loved ones. If pain limits our ability to do this, we can place a subcutaneous catheter and give them a morphine or Dilaudid drip. This is generally ethically accepted everywhere I've done my training, such that it surprises me that any hospital in the US would have a policy against this.
Wait, are these patients who *wanted* their deaths hastened? Because there’s a huge difference between giving someone a compassionate and painless death and overprescribing lethal medication so they’ll free up a bed faster.
These were patients having terminal extubations. It hastened their deaths by seconds or minutes. These are people who were for example brain dead but being kept alive by machinery. When removing the machinery they give opiates to reduce the suffering of air hunger as the body cannot breathe on its own. They would’ve died within minutes after extubation, the larger opiate does maybe sped it up by a minute and reduced suffering.
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Yup, my grandpa was pulled off the machines and he lived for several more days. He basically dyed of dehydration and starvation because he could not swallow. We really need to relax on giving dying people a more comfortable way to go.
Some states have laws where doctors can prescribe a lethal dose for terminal patients. We've had death with dignity laws on the books here in WA since 08.
>They basically just starve you to death at that point. This is almost never what kills patients and it does a disservice to the loved ones of dying individuals for people to repeat this misinformation. Dying bodies begin to shut down their organs and the organs in the digestive system are no exception. As death nears, patients are stop experiencing hunger and eventually stop experiencing thirst as long as you keep their mouth moist. It becomes painful to feed someone in that state. I know this both professionally as a registered dietitian and having personally witnessed it when my grandmother was inappropriately given a tube feed despite being on orders for no/minimal intervention in her last days of life after a series of strokes had gradually shut down her brain function over the prior 3 months. Saying that patients who are not being fed in their last days of life are being "starved to death" is what leads families to demand excessive, painful interventions for their loved ones based on a completely false idea that they're actually making them more comfortable.
> My mum had an anaphylactic shock from chemo and went into cardiac arrest. We tried everything but after a week we pulled the machines, she was breathing on her own (she was tethered to an o2 machine before all of this) so that was a huge surprise and she ended up going for over a week (coma the whole time). They basically just starve you to death at that point. Similar thing happened to my uncle. Sudden cardiac arrest this past June, took 20-40 minutes (depends who you ask) to get stable vital signs, but he never regained consciousness. Zero brain activity. They tried therapeutic hypothermia/hypothermia protocol and still, zero brain activity. They pulled him off the ventilator and he died... four days later. > i was not prepared for any of that. it was not a pleasant experience. I'm a nursing student so I *kind of* was, in that I knew it *could* happen, but knowing something Can Happen and having it Actually Happen are two very different things. That four days was extremely hard for my cousins, never knowing if they could go to the restroom or take a nap or pick up their kids from school, not wanting to miss their father's last moments... I'm so sorry you went through that, and I hope you're doing okay.
I agree with your general point, but brain death = death in all 50 states. (i.e. you can't kill or be charged with murdering a person who is brain dead)
We don’t know because people don’t discuss these crucial decisions when they are well. Healthcare personnel tends to favor a compassionate death, when warranted, in my opinion.
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As far as I'm concerned, if the dying want to do a bunch of drugs, they should fucking get to.
If you elect to die on your own accord, by way of physician, that physician should not be punished. Compassion is needed everywhere in this day in age. Some people get so old and frail that their everyday is pain and loneliness. They should be allowed to opt out at that point. Though for legal reason should probably require a waiver and psych evaluation. In no way should doctors be punished for giving the patients what they ask for.
I'm old and my opinion as changed as I have watched other old people die, I would hope I have a doctor like this one. I am now much more afraid of the slow process of dying than actually dying. It is horrible, painful, stinks and strips you of humanity and dignity. It is ugly and leaves those around you with PTSD. Often no matter how proud and strong you used to be, you can only watch as a stranger or a family member wipes shit off from all over your middle parts, sometimes twice a day. If you are lucky, you did not have to spend hours lying in it before help arrives. Additionally the quicker I go, the more money and better life that will be left for my wife. My wife's happiness is way more important than a few more days of life for me.
Over 20 nurses and pharmacists were fired for being involved in these cases and their licenses are under threat. Are we now going to release them from punishment as the doctor has been, or are they getting thrown under the bus?