quote:

ORIGINAL: StrangerThan

I've watched a lot of older folks die. Not nearly as many as doctors and nurses, but coming from a large family, it has been a fact of life. To give some perspective, I remember my great-great-grandmother, 5 greats, all my grandparents, their sisters, brothers.. well you get the picture. Most passed from old age, I reckon, a couple from cancer, another one from heart problems. Even so, we're talking upper 70's to upper 90's as the age ranges.

In the past couple of weeks, we've had two deaths in the family, a grandparent, a great-uncle. I don't know if I've just been blind in the past, but in witnessing the decline of these last two, a large number of similarities sprang to mind that cover the final few days. The final passing was presaged by the same types of care in many cases, that being hospice.

I'm not going to go into great detail, nor am I questioning the care itself, it just struck me that part of the process of providing comfort for the final days is sorta what actually kills the patient. Hospice folk provide good care. They can tell within hours of when someone will pass. But... part of the care is termed comfort. That has generally meant, at least from what I've seen in my own family, drugs to ease the pain, and foregoing things like food and water. Most couldn't eat if they tried. Most are unconscious. But seems to me the lack of fluid is the actual killer. Face it, take water away and people die within a week or two.

The thought surfaces if these are reallly the stages of natural death or in actuality, the stages of dying from thirst. From that springs another side issue, that of assisted suicide. At least one state, Oregon, has legislation on the books that will allow an otherwise competant person of sound mind who is terminally ill, to have some say in the timing and nature of their death. There are plenty of arguments pro and con, but having watched this enough times, I'm pretty much on the pro side.

I'm interested in comments from those in the health care field because it seems to me the role of the care provider in the last few days is both to provide comfort, but also maybe, hasten death? That's a bad way of putting it but the emperical evidence seems to suggest it. Then again, although I know what I see, I have little knowledge as to how that breaks down in terms of natural things.

I'm not looking for arguments, but more so an understanding.

• increased restlessness, confusion, agitation, inability to stay content in one position and insisting on changing positions frequently (exhausting family and caregivers)
  
• withdrawal from active participation in social activities
  
• increased periods of sleep, lethargy
  
• decreased intake of food and liquids
  
• beginning to show periods of pausing in the breathing (apnea) whether awake or sleeping
  
• patient reports seeing persons who had already died
  
• patient states that he or she is dying
  
• patient requests family visit to settle "unfinished business" and tie up "loose ends"
  
• inability to heal or recover from wounds or infections
  
• increased swelling (edema) of either the extremities or the entire body

• inability to arouse patient at all (coma) or, ability to only arouse patient with great effort but patient quickly returns to severely unresponsive state (semi-coma)
  
• severe agitation in patient, hallucinations, acting "crazy" and not in patient's normal manner or personality
  
• much longer periods of pausing in the breathing (apnea)
  
• dramatic changes in the breathing pattern including apnea, but also including very rapid breathing or cyclic changes in the patterns of breathing (such as slow progressing to very fast and then slow again, or shallow progressing to very deep breathing while also changing rate of breathing to very fast and then slow)
  
• other very abnormal breathing patterns
  
• severely increased respiratory congestion or fluid buildup in lungs
  
• inability to swallow any fluids at all (not taking any food by mouth voluntarily as well)
  
• patient states that he or she is going to die
  
• patient breathing through wide open mouth continuously and no longer can speak even if awake
  
• urinary or bowel incontinence in a patient who was not incontinent before
  
• marked decrease in urine output and darkening color of urine or very abnormal colors (such as red or brown)
  
• blood pressure dropping dramatically from patient's normal blood pressure range (more than a 20 or 30 point drop)
  
• systolic blood pressure below 70, diastolic blood pressure below 50
  
• patient's extremities (such as hands, arms, feet and legs) feel very cold to touch
  
• patient complains that his or her legs/feet are numb and cannot be felt at all
  
• cyanosis, or a bluish or purple coloring to the patients arms and legs, especially the feet and hands)
  
• patient's body is held in rigid unchanging position

quote:

If I ever once thought that someone had hastened his death, merciful as it was, there would have been hell to pay.

quote:

ORIGINAL: juliaoceania

quote:

If I ever once thought that someone had hastened his death, merciful as it was, there would have been hell to pay.

If I am in horrible pain from which I will never recover, please drug me to death.....

Thanks in advance!

quote:

ORIGINAL: kiwisub12

My late dom died recently - from cancer, and hospice were the inhome caregivers. They DID NOT hasten his death. What they did was provide physical care - washes, assisting me to change his sheets and so on. They also provided the pain meds and other needed meds.

Because of them, i was able to have my Sir in my house until he died.

And i am a nurse, and have cared for people dying of cancer. I remember one lady vividly, she had bone cancer and fractured her femur -thigh bone - in such a position that it couldn't be fixed so she could leave the hospital. We cared for her for 6 months,  in traction and in pain - and if the medicine i gave her to control her pain made her breathing shallower, and hasten her death - then that was what it took to manage her pain.  And i feel no remorse for it.

If you talk to anyone who has cancer the primary thing they are afraid of is dying in pain - and there aren't too many of them who would think that losing a few hours and being comfortable isn't a good trade-off.

Honestly though - no-one prescribes or gives medication to "hasten" death. Its unethical, but if the treatment given for pain also hastens death, then that is the price we pay for a semblence of comfort at the end of our lives.

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ORIGINAL: kiwisub12

Honestly though - no-one prescribes or gives medication to "hasten" death. Its unethical, but if the treatment given for pain also hastens death, then that is the price we pay for a semblence of comfort at the end of our lives.

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ORIGINAL: ThatDamnedPanda

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ORIGINAL: kiwisub12

Honestly though - no-one prescribes or gives medication to "hasten" death. Its unethical, but if the treatment given for pain also hastens death, then that is the price we pay for a semblence of comfort at the end of our lives.

Not necessarily true. When my father died a couple of years ago, there was no doubt at all that he was being euthanized. He knew it, we knew it, and the doctor made only a token attempt to conceal it. The purpose of the morphine/atavan drip was to kill him, as painlessly as possible. He understood it and agreed to it, repeatedly, until the doctor was satisfied that he knew exactly what he was consenting to. I could not have been more impressed with the way that it was handled, by all parties.

quote:

ORIGINAL: kiwisub12

Wow - your fathers doctor was exceptionally brave/stupid.  I've never seen any doctor who would put his license in jephardy like that.  And i certainly don't disparage him or your family for going that route. I have no problem with assisted suicide in hopeless cases, as long as, with your dads situation, everyone is on board.