When do you give up and die?

At what point is it best to give up and die? Or perhaps when do you stop treatment for a family member and let them die?

I never understood the term "Better off Dead" until my mom got cancer for the second time. She died a miserable long death, but she she did not take treatements up until the very end. In her case the disease was just slow in taking her life.

This article seems to indicate that doctors are not giving up until the last days, and perhaps neither are many patients and families.

I've told my wife that I do not want to live if there is no cure for any illness I may get. I told her that if she had to pull the plug, just do it and get it over with. I for one do not want to be the one suffering and causing everyone around me to suffer also.

My wife is a nurse and has worked in oncology in the beginning of her career and has been in critical care at least 15 of the last 20 years. She sees people trying to hang on as long as they can and families trying to hang on even longer; sometimes even after the patient wants to let go. I also lost my own father to pancreatic cancer in 1987. He was 61, and died within 4 days of the discovery of the cancer in the V.A. Hospital in Atlanta. His cancer was mis-diagnosed as diabetes and he was actually taking insulin shots daily for over a year. By the time they did the emergency exploratory surgery because of his severe abdominal pain, the cancer had grown throughout his abdomen. The doctors likened what they saw to a massive growth of cauliflower inside his abdomen; the only thing to do was to close him up and make him comfortable with a morphine drip and family at his bedside. Even knowing that death was inevitable, my mother requested a resuscitation attempt when his heart finally stopped. She just could not let go; she had loved and depended upon him for almost 40 years. Looking back, I believe it was actually a blessing that he was misdiagnosed as opposed to finding out early and going through a long period of suffering and hoping against hope. There is little chance for survival of pancreatic cancer, especially back then. At least we had him with us for that last year and he was able to be active. Had we found out earlier, it would have likely been the routine of debilitating chemotherapy that so many patients and families suffer through.

I am continually amazed at the families my wife tells me about who demand that the hospital staff make all attempts to resuscitate a beloved elderly father, mother, grandmother or grandfather in his or her mid 80’s or older; even after the doctor has told the family that resuscitation attempts are medically futile. The critical care team responds when the heart stops, applying chest compressions which break brittle ribs and applying wrenching electrical shocks. The person dies a violent death instead of being allowed to peacefully pass on.

My wife and I have reached an agreement the neither of us will allow the other to languish on a respirator or feeding tube or other life support should the situation arise. We believe we should be allowed to depart this life in as much peace and dignity as possible. If we are fortunate enough to make it into a ripe old age well into the 80’s or 90’s, when it is time to go, there will be no resuscitation attempts. While it may be uncomfortable for some to think about the inevitability of death, it is wise to plan as much as possible for what we all know must some day come for all of us.

Long story short, called at 10 pm with my father that my mother took a turn for the worse at the hostial. Get to the hosptial at 10:30pm, have to wait 4 HOURS an no one would still see us or let us know what was going on with my mother.

Finally, went up to the counter and asked the nurse to sign a piece of paper "I had written up". She asked me what the paper was for. I told her I did not want my mother kept alive by unnesessary (sp?) means, and that if she was, I would sue the hospital.

IN TWO MINUTES I was brought back to see her after having to wait 4 hours or so.

Father could not make the call, I asked the doctor what he thought the chances were of her "coming back" and then what she would have to go through (going on a fourth valve replacement).

Dad could not even be in the same room (he stayed out in the waiting room), I told the doctor to take her off life support, amazing she was still breathing after that. I asked the doctor why, apparetnly because she could still breath with that tube in her mouth (although the machines were not helping her). I then told him to take the tube out of her mouth, stayed next to her as they pulled the tube out with my head on her chest crying like a baby.

One of the hardest things I EVER had to do, and still cry when I think of that time.

A part of me asks if I killed her (which I know isn't the case), but still hard.

My only saving thoughts were that my father told me he was grateful to have me as a son and we would always be thankful that I made the decision and he didn't have to.

Its difficult to deal with death, no doubt... When my grandparents died(grandmother with pancreatic cancer too BTW), I wathced them both suffer, knowing they were dying for over a year.... Both of them good upstanding, god fearing christian people, but thats another story all together.... My grandfather had brain cancer and barely knew who he was when he died and was miserable, not from pain, but from knowing he had digressed to the mentality of a child.... My grandmother on the other hand had the presense of mind to make all of her arrangements and speak with the family regarding EVERYTHING, to make sure she had no regrets when she died.. He died a peacefull death in hospice, just stopped breathing with all three sons and wife by his side... She, on the morphine drip for weeks due to constant pain, woke up screaming and hemoraging, untill she blead out in her own bed....... Anyone who desires to keep someone alive longer than their body can do so on its own is..............we ll I cant agree with it...... I for one believe we need more people like Kavorkian to help some folks, like my grandmother, so they dont suffer... If she asked, I would have done anything to take the pain away from her, but her religious faith would have told her it was suicide and wrong...

I believe allot of the recesitation and late treatment options are driven both by family mebers who cannot let go and greed of the medical comunity..

HGM said:

I believe allot of the recesitation and late treatment options are driven both by family mebers who cannot let go and greed of the medical comunity..

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Interesting enough, when I was finally allowed to see my mother, I asked the doctor (on duty at the time) point blank what would he do if it were his mother in that bed (as my mother). He "beat around the bush" a little and told me he could not make that call for my mother, but he finally told me that if it was his mother, he would take her off life support due to the condition of her heart.

The impression I got was he was afraid to tell me to take her off life support.

dzalphakilo said:

Interesting enough, when I was finally allowed to see my mother, I asked the doctor (on duty at the time) point blank what would he do if it were his mother in that bed (as my mother). He "beat around the bush" a little and told me he could not make that call for my mother, but he finally told me that if it was his mother, he would take her off life support due to the condition of her heart.

The impression I got was he was afraid to tell me to take her off life support.

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You did the right thing making that decision. The doctor couldn't tell you his opinion because it opens him and the hospital up to a lawsuit. Here is the reasoning behind this. A good (crooked) lawyer would say that you were under severe strain and deress. You let him tell you what to do. You were not of your right mind and really wanted your mother to live. The doctor on the other hand told you to let her go. You never wanted her to be removed but took the word of the doctor. The lawyer sues for wrongfull death and you get rich. It's a pretty sick world out there when you come right down to it these days. The doctor has to cover his butt every time.

dzalphakilo said:

Interesting enough, when I was finally allowed to see my mother, I asked the doctor (on duty at the time) point blank what would he do if it were his mother in that bed (as my mother). He "beat around the bush" a little and told me he could not make that call for my mother, but he finally told me that if it was his mother, he would take her off life support due to the condition of her heart.

The impression I got was he was afraid to tell me to take her off life support.

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I agree that he had to beat arround the bush a bit for legal reasons.. I also firmly believe you did the right thing, its a tough decision, no one wants to make...

My father died of congestive heart failure. I'll never forget when he died, we were all at the hospital with him and he died. After a moment or two I hit the nurse call button. She asked what we needed and I told her that my dad had just died. He had a DNR order. But they came in with a large needle and were going to try to revive him. He had been unable to open his eyes for 2+ days. What type of life is it when you can barely breath? And still they wanted to revive him.

For what? So he could die later on that day? Or the next? What is the point?

They were probably covering themselves from legal liability by being prepared to revive him in the event you changed your mind. Also, there are different classsifications of DNR, such as DNR-No CPR where they may take other measures such as utilizing drugs, etc., to attempt resuscitation

Well I'll admit my igorance on the types of DNR orders there are, but I will say that I put myself in between that nurse, with a 6" long needle (and the group with the 'crash cart' that entered the room behind her) and my dad. I have no regrets about physically preventing them from restarting his heart.

You did the right thing; and I bet the staff with the crash-cart was actually relieved by your decision. Citygirl thinks so too.

Bob, You did the right thing. 10 years ago my FIL had congestive heart failure. My wife, the kids and I had just left for vacation the day before. We got a call from my MIL who is hysterical that dad had fallen on the ground and wouldn't get up. She had already called 911. We told her to go to the hospital and call us back with the details as it was a 3 1/2 hour drive back home. 30 minutes later she called again. My FIL was brain dead and was being kept alive by machinery. He had no chance of recovery. I was talking with my MIL and told her to take him off life support. She couldn't pull herself to do it. My wife and son drove back to pull the plug on my FIL. My daughter and I packed up all our belongings for the trip back home. It was a good thing we took two vehicles on vacation. Otherwise he would have been kept alive for many more hours for nothing. I saved the old goat (smile) back in 1981 when he blew a main artery from an aneurysm. He was pissed off at me about that for many years to come. Our kids came along two and three years later. He finally thanked me for saving his butt about 10 years after the fact. I gave him 15 more years to live and enjoy life.

HGM said:

its a tough decision, no one wants to make...

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Agreed, that being said, it's somthing that every once in a while "comes back to me" and thinking about it, breaks me down.

I do however think that when my mother "had severe trouble" at the hospital, THEY did everything to keep her alive to the point that when I had to make the decision, I only "stop and retracted" what they did so she could die quicker at that time.

I was PISSED that we made the hospital in 30 minutes and then had to wait, asking every half hour to see my mother, and they said that they "were still working on her" and I couldn't see her. This going on to close to four hours.

It is somewhat strange when you tell someone to do "a procedure" to your loved one and you know when they do it, their life will end in moments, while at the same time you are watching them and thinking about what they mean to you.

I guess the greater the pain, the greater the love. Somewhat ironic.

My only consolation (sp?) is that when "my time comes" (which will be in a blink of an eye compared to things in this universe), I will be with her.

My wife and I have living wills. We signed them, distributed them and take them seriously.

When my father died 2.5 years ago, they had better not tried to bring him back. it was not going to happen anyway. He died peacefully, the nurses came in and 2 others left immediately. They knew it was time, time to let him go. I knew it was time, and I would have fought tooth and nail to make sure he did not come back as he left. There was no healing him, but he got the ultimate healing.

Today he is walking streets of Gold, by the river of life, never to feel pain again.................................

Praise the Lord above!

Danny I started this thread because I know how easy of a choice it was to let my father die the way he died, and I know how hard it was to see my mother linger on for way too long. Both died many years ago. But the news story I posted brought both situations back to life for me.

Sometimes you truely are 'better off dead' than alive.

I'm not in favor of mercy killing. I don't believe in putting the elderly on iceflows and setting them adrift (as is rumored the eskimos did). But damnit, sometimes treatments should stop and people should simply be made as comfortable as is possible.

Many times it depends on the type of hospital that you are in. If you go to Saint Mary's in Waterbury, CT, then they will do everything humanly possible to keep you alive. If you wind up in Waterbury Hospital, a non religious hospital, your family wishes will be closely followed. It is unfortunate that some people allow religious beliefs to interfere with medical certainties, but that is their personal choice. For the US Congress to pass legislation and the President to sign it concerning Terri Schiavo which should have been a private family matter of when to pull the plug is astonishing. I am still wondering if that whole episode was politically motivated or religiously motivated. Either way, it was wrong in my opinion for the government to get involved in a personal family tragedy. The same happened with Karen Ann Quinlan in NJ. She was originally taken by ambulance to Newton Memorial Hospital, and later transfered to St. Clare’s, a religious based facility. That facility felt that it was their moral obligation to continue her life. Karen Ann had suffered cardiopulmonary arrest in 1975 and lived for the next 10 years in a vegetative state. Her parents fought for the right to have their daughter removed from the respirator and die in a natural state with dignity. On March 31, 1976, the New Jersey Supreme Court handed down the landmark decision affirming the right of us all to make fundamental decisions at the end of our lives. This decision has spread to all 50 states I believe.

If you would like to read the entire story of Karen Ann Quinlan, click here..... Junk...

Postscript... The one thing to always remember when preparing a "living will", is that the person that you name will ultimately be making the decisions, and those decisions are his/hers alone to make. They can legally totally disregard your wishes and do as they see fit. I know this because while signing my living will in front of my doctor telling him exactly what I would want, he informed me of this. This is the way that the law in MA is written. It might be different in other states, so check your states laws and regulations first before appointing a person that will be speaking for you. In my case, I wanted to name my doctor, but he said that there was a conflict. I would appoint my wife, but I am afraid that she might pull the plug if I break a fingernail.... I am worth more dead than alive!!

Junk, and everyone. I always find it amazing that "religion" makes a big deal out of staying alive, when the whole idea of religion or leaving this world is the better one that awaits us. I can die assured knowing that my belief and understanding of forgiveness as told in the bible is True. I also know that the second I leave this world I will be in His heaven, and all the pains of this world will be over for me. I can not see into this world at that point. My pastor had best just let me go, and plan on doing a short funeral after which there is ONE GREAT BIG PARTY! No black at my funeral either, colorful, festive, happy. Celebrate that I woke up in the hands of God, not that I left this world.

Ironic that I'm reading this thread on the 10 year anniversary of my Dad's passing.

Junk, they call that a durable power of attorney for health care here in Ohio. A living will is your direction, no one else's, and assuming there's proof of legal competence at the time of execution (assuming the will is contested), it trumps the DPOA.

I too lost a parent after she lay for months in a "Schiavo state." How awful. You see these reflexive activities that mimic the use of grey matter, but in actuality, it's no different than tapping on you knee to make your leg jerk. Mom's passing ended a great deal of misery for her and her children. Thank God she had the living will. Those folks at hospice care were a true blessing also.

I think the only way you can make this type of decision is to have some idea of the wishes of the individual. Some people would much rather die than face the pain - others would want to fight to live no matter what it took. In the end I think it is the duty of the loved ones to respect what you think the wishes of the loved one would be. The last time I had to face something like this with a relative was over a decade ago when my grandmother was in the hospital - she was incoherent and the doctors said she would not live more than another day without intervention. My mother asked for advice and I told her that I thought we should let her go naturally without being hooked up to tubes and machines.

Last year however we had one of our cats very sick with intestinal cancer. While she was getting progressively worse she did have times when she would get a little better and still obviously enjoyed being around us. My wife and I had some arguments over the best way to approach this - I was for letting her life play out until the point when it became patently obvious that she was in pain and could not eat or enjoy anything any more. My wife thought that making her suffer pain was being cruel - but I felt that just the presence of pain itself is not cause for putting the animal down because every person, and animal experiences pain differently. While it was obvious that the cat was not in the best of spirits at times she did also still enjoy spending time with us and the times that I would let her out to walk around and explore in the yard. This particular cat was also pretty tough - she had been a stray and had raised a litter of kittens on her own, and she did not put up with anything from either of our other two cats, so I felt that putting her down prematurely was not doing my duty to her to fight for her as long she wanted to fight. In the end she died naturally in the early morning of the day we were going to bring her in to get her put to sleep. Death is not pretty - but it is what it is - by trying to make it "easier" we take away some of the stigma and the "naturalness" - if you will of what it is.

As already noted by others, a Living Will or DPOA can help make the decision.

dzalphakilo said:

Long story short, called at 10 pm with my father that my mother took a turn for the worse at the hostial. Get to the hosptial at 10:30pm, have to wait 4 HOURS an no one would still see us or let us know what was going on with my mother.

Finally, went up to the counter and asked the nurse to sign a piece of paper "I had written up". She asked me what the paper was for. I told her I did not want my mother kept alive by unnesessary (sp?) means, and that if she was, I would sue the hospital.

IN TWO MINUTES I was brought back to see her after having to wait 4 hours or so.

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If you have a major issue such as this, there's a relatively simple way to get results.

After waiting a reasonable amount of time (not 4 hours in your case), notify the unit clerk or whomever is at the desk and say "I would like to speak with the AOD". Then watch people start doing hoop jumps.

The AOD is the "Administrator on Duty". This person is normally an executive level member of the hospital and when on duty, is the senior voice of the institution. The person is available 24/day and WILL come see you.

If the staff has in fact done something wrong (as they probably did in your case), not only will the AOD get it resolved quickly, the AOD will most likely be having a little talk with the department head(s) afterwards. Those meetings don't go very well as the dept head gets their butt chewed. After that, poop rolls down hill to the staff.

B_Skurka said:

At what point is it best to give up and die? Or perhaps when do you stop treatment for a family member and let them die?

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I was a lucky person to have had my Mom. She passed a few months ago. In a Hospice. My dad took care of her until the last few days. She had been diagnosed with agressive cancer as she lay near death in the hospital for heart/blood issues over a year ago. When asked, of clear mind she said, "no treatment, let me go". When she stablized, the doctors KNEW she had only days with the cancer. She did accept a "quality of life" treatment, "no pain", and went HOME after a week in the hospital. Having recovered WELL enough to over the next few months actually get around and LIVE again. A strong women.

She made it 15 days past her 80th birthday. Fighting the cancer now till the end, with a cocktail drug the FDA just approved for wider dispersion.

She was expected to live days.

She got another year of quality life and love out of them.

I don't know the answer on when, but I know without people like my mom, others will have the hope and drugs available to close out their lives on thier terms and at thier time.

I know she gave others this chance, and gave the medical community a new weapon to deal with this disease.

Stumbled upon this thread and it was a good informative read. I am already making some plans for when my time comes. I have been concentrating mainly on financial and legal things but will move on to the living will etc. as time shows the need. I have a hard time with folks who can not let go of someone fatally ill because they don't want to face reality. Thanks for the input.

Mine has been done now for the last year including living will and general will.

muleman said:

I am already making some plans for when my time comes.

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Can I have your Prius?

A living will is a good idea.
I keep seeing a commercial over and over for a Cancer treatment center. In a way I think that gives people false hope. When my mom was diagnosed with lung cancer she made the decision just to die a naturally no treatment we respected her wishes. Sometimes I wish I had had a living will. Sometimes I think to much was done save me when I almost died in a car accident several years ago. All of my left leg and part of my left arm was rebuilt internally with titanium. I have a Vagius nerve stimulator in my chest that somewhat controls my seizures. Sometimes I feel like a cyborg. I can't drive due to the seizures. I am on so many prescribed drugs it's ridiculous. They have made me into a chemical zombie. So I ofen think that doctors have gone to far.

All I ask is to have the BALLS my dad did.

my mom was dying for 3 years and you could see it in my dad she was in a nursing home and completely out of it being fed by a tube not responsive.

When she passed my dad said he wouldn't go through that!!!

He went through the 1st bout of cancer was ok.
Then he had enlarged aortic artery had it fixed and he was in the hospital when George C Scott died of a ruptured one.

Doing fine again and got a bad skin infection on his leg and lung cancer and due to the 1st treatment he couldn't take any more radiation or Chemo.

He talked to the hospice when he got bad and said to keep the pain in check with medicine and not one thing else no food or any thing. It took him 5 days to pass after making the resolution but he went with dignity and in peace with all of us there.

tom

My Father chose to give up and die after a 6 month battle with lung cancer.
He was a 4 pack a day smoker since the age of 14.
He passed away in a hospice bed in the dining room of his and Mommy's house.

Another sister of mine and her daughter were killed in a car crash in February prior to his death the following July.
They said she still had some heart rhythm when the EMS got there, but there would have been no saving either of them, not after having your car basically ran over by a school bus.
I think she wouldn't have wanted to live anyhow.

My Mother passed away after a fuck up with a colonoscopy when she got nicked during the procedure.
Sepsis and other complications- next thing we knew.. she was put on life support.

My sister Julie who passed away recently on February 22 chose to end it.
She didn't want any more meds for her other conditions, it was agreed thru hospice to go the way of comfort care right down to the end, and she fought for a long time.

If I ever come down with some sudden disease that's going to make me suffer with no hope, or if I am the victim of an accident with no chance of recovery.. let me go.
Seen too much suffering in my time on this earth.

muleman said:

Stumbled upon this thread and it was a good informative read. I am already making some plans for when my time comes. I have been concentrating mainly on financial and legal things but will move on to the living will etc. as time shows the need. I have a hard time with folks who can not let go of someone fatally ill because they don't want to face reality. Thanks for the input.

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Thanks for resurrecting this thread, Muleman, a thread laying dead for five years. The topic is so important, and everyone should have plans, and those wishes should be available for family when the time comes.

A living will - either published to close family or at least tucked away somewhere handy - is intended to give comfort to loved ones that final health care instructions are clear and concise, particularly given the stress of HIPAA constraints of notification. The last thing I would want to do is cause any woe to my family when it is time to give instructions as my health care POA to a medical team.

Maybe I am fortunate (lucky?) enough to have lived thru the process, resurrected from the dead if you will, a few times and understand the stress associated with passing, not only personally, but to family: once with near-fatal sepsis (the condition PG's mother died from), another time with complete pulmonary failure during a routine procedure, and a third time with a busted abdominal aorta. All three times, particularly the 10-day bout with sepsis and emergency surgery, the doc's say most people would not have survived. Not sure how the wife feels about it, since my orders were to DO NOT RESUSCITATE. In any event, I speak from the experience of a man that has cleared his scorecard-of-life a couple times. Dying was OK.

And that score card is what likely troubles most people when faced with the inevitable. For some, death is accidental and sudden - maybe a blessing. For others, death comes as a slow, lingering process. And others may have to settle the score-of-life during a brief ride in the ambulance. So the responsible person - for the sake of the family - should have a will in place that avoids state probate constraints and a clear and concise living will in place giving health care POA to appropriate parties under HIPPA regulations.

Oh, and update your own score card every day the sun rises. End up with the right regrets.
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