Posted on 11/09/2013 5:07:39 AM PST by marktwain
These events occurred very recently. No names are given so that no one need fear approbation or lawsuit. I stand behind the facts given, but will not reveal sources.
An elderly woman was examined by her doctor of many years. Her family has a deep split in how they believe that care should be delivered. Half believe she should be cared for at home, and that her wishes about pain medication should be followed. The other half has expressed a desire for her to be in a nursing home, and believe that she should be given stronger (narcotic) pain medication, even if she says she does not want it.
A major issue is competency. The half that wants more pain medication says that she is incompetent. The other half says that she is competent. The half that claims she is incompetent said that they would ask for a second opinion from another doctor while the personal doctor was doing the examination at the woman's home, because the woman cannot easily be moved.
The doctor, after examining the old woman (late 90's) alone, came out and talked to the family. The doctor said, well, the woman knows a lot, and in many ways is competent. She knows what year it is. She knows that Obama is president. She knows who I am. She can do simple arithmetic, and she understands what is going on around her. But, in some ways she has unrealistic expectation about reality. She says she wants to live. That is very unusual in patients this old and in this condition. When I asked her if she needed surgery in order to live, she said that she would undergo the surgery. If you, as a family, decided that she should not undergo the surgery, I cannot think of a surgeon that would not back you up.
So, with these unrealistic expectations of reality, she could be found incompetent, or she could be found competent, depending on what the person who was making the finding desired.
A family member spoke up, and said that the choice given the old woman was a false one, so her decision was not unrealistic. She was given the choice, take surgery or die, not take surgery and die or do not take surgery and die. Given the choice that you presented to us, she might make a different decision.
The doctor allowed as that was true.
The doctor also said that if asked, and she says that she does not want the stronger pain medication, you can try a different tact. Do not ask her if she wants it, just tell her "Here is your pain medication" and give it to her.
I respect the doctor. It is a difficult job, and fractious family dynamics make it more difficult.
However, I found the advice chilling. A desire to live, even in an invalid state, is taken as a sign of incompetency. A patients desire not to take strong pain medication may be overridden by subtle subterfuge, because the patient is very old and debilitated.
There is no significant estate in this case, at most it would be a few thousand dollars.
While medical decisions are not the focus of this blog, some things the muse demands be written.
The woman sounds like a Catholic
Catholics like me, believe that death is between them and God, that you are supposed to live this life (hellish as it may be) not kill yourself.
The narcotic pain meds can be a surreptitious means of death by overdose. “nursing” homes are evil in many cases. Leaving patients in their own mess, placing food trays out of their reach, the people that work there develop a sick sense of their power of life and death over their patients. Additionally they are ridiculously expensive.
Keep the poor woman at home, don’t warehouse her in the blind belief the “nursing home” would give better care than you at home. It is just a job to them and they don’t love her. She could go for weeks without seeing anyone who loves her in a warehouse like that.
I do not want to be an invalid or a burden to anyone. I do not fear death-—death just pisses me off. I have too many things left to do.
At what age and at what degree of infirmity do we actually seek death?
I believe that is a very personal decision.
It is and that is the point of the story. The old lady made her decision and the others are not happy with it.
Bingo, marktwain!
This example is a very good example to demonstrate the need for clear, concise PRE-NEED healthcare decisions and instructions by means of EOL statement, living will, whatever vehicle your state allows.
Even that, though, is not enough. You must communicate the details to ALL concerned. Granting a healthcare POA to a family member or trusted friend can create friction, but it if everyone is aware, there is little argument later.
Of course, Zero and 0bamunists will have their death panels enabled shortly, so some EOL decisions may be obviated by the socialists.
I second everything you said! From personal experience, pain meds scripts are written with a WIDE “as needed” dosage. Even in my mom’s last hours at home, we wound up with a hospice nurse determined that SHE would see Mom leave us. Thankfully, when I called to get more meds, the nurse on the other end questioned the need for more morphine. Thankfully, the nurse whose shift was ending shared what the evil nurse told her and evil nurse was outta there in less than two hours on a holiday. Mom did leave us the next morning - when God called her.
The selfish family wants to put her out of THEIR misery.
Um, a strong desire to live at any age is not exclusively Catholic. I am a Baptist and would take the same position. As an attorney, I also encourage others who are staunchly prolife to have their living wills written to incorporate their prolife beliefs. It's actually fairly involved, lots of things you might not think of, but it can be set up in advance, while you're still independent.
There are some important omissions here, that might cast some light on her situation.
I assume her family can be subdivided into the caregivers who live with her, and those who do not live with her. It is important to know which group supports either alternative.
Caregivers can become exhausted, and/or unhappy with the behavior of the person being cared for. They may be unable or unwilling to provide more care at home.
Either group may have “false empathy”, projecting disability and discomfort on another person as they imagine it to be, not how it actually is. A good way around this, used by hospitals, is to frequently poll discomfort and pain of the patient, using a “one to ten” scale chart.
http://i.imgur.com/lN9bN5c.jpg
In either case, it is important that she get her paperwork in order, or it could turn into a family brawl. That is, her will, any family trust, her living will and resuscitate (or not) order, her (unsigned) power of attorney, (and with some research) her preferred hospital (differences between hospitals are becoming greater and can mean the difference between life and death.)
It is also important to know at what point, if any, she is willing to go to a nursing home or hospice.
I do the same as an attorney.
If people believe in death being between them and God, it has almost reached the point of having to have a legal document that says so.
Also, no one can lay their hands on the doc when the car wreck or whatever happens, so I encourage churches to start a filing system for the docs because your pastor will know you have been in a car wreck and can calmly produce it.
Your lawyer may not get notified and your paper docs may be in disarray at home or not retrievable by a panicked family member.
The Last Leaf by Oliver Wendell Holmes Sr. (written 1831, when Holmes was 22. He was father to the famous Supreme Court Justice.
I saw him once before,
As he passed by the door,
And again
The pavement stones resound,
As he totters o’er the ground
With his cane.
They say that in his prime,
Ere the pruning-knife of Time
Cut him down,
Not a better man was found
By the Crier on his round
Through the town.
But now he walks the streets,
And he looks at all he meets
Sad and wan,
And he shakes his feeble head,
That it seems as if he said,
“They are gone!”
The mossy marbles rest
On the lips that he has prest
In their bloom,
And the names he loved to hear
Have been carved for many a year
On the tomb.
My grandmamma has said—
Poor old lady, she is dead
Long ago—
That he had a Roman nose,
And his cheek was like a rose
In the snow;
But now his nose is thin,
And it rests upon his chin
Like a staff,
And a crook is in his back,
And a melancholy crack
In his laugh.
I know it is a sin
For me to sit and grin
At him here;
But the old three-cornered hat,
And the breeches, and all that,
Are so queer!
And if I should live to be
The last leaf upon the tree
In the spring,
Let them smile, as I do now,
At the old forsaken bough
Where I cling.
She wasn’t referring to the desire to live, but rather it is very common that Catholics offer their pain and suffering to God for mercy. This is not so common with other religions that usually have a “take what you get” approach to suffering as opposed to a send it up to God approach.
Good points all, and an excellent pattern of practice for Christian attorneys of any denomination.
I guess I don’t know which other religions you’re talking about. Again, speaking as a Baptist, and one who has done some of the suffering of old age, I cannot even imagine not holding it up to God for mercy. My desire to outlive my difficulties is not this “take whatever you can get” business of which you speak. I’m not even sure what that means. What I do know is God has work for me here, and I have no business trying to quit before the end of my day of work. I do seek his help when holding out that long seems too hard. And thus far he has held me up and kept me going. I ain’t going anywhere till he turns out the light. I don’t see that in denominational terms. It is the normal state of anyone who puts their faith in Jesus. I am a Christian first, a Baptist second.
That is an understatement of monumental proportions. I write from personal experience with someone who was closer to me than anyone else ever was or ever will be. I am looking at her photo as I write.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.
