End Of Life Treatment And Natural Death
This article is part book excerpt and part encouraging families start the conversation. This is not a discussion on doctor assisted death.
The past 18 months have caused me think about how we die when we become elderly. My mother died July 2014 (age 90) and my father November 2014 (age 94). I have written about them and their funerals in previous articles (archived at AnniMarkmann.ca). Since my parents have both passed away I have been reading more about how well (or not so well) our elderly family members die. Or how we extend their dying and not allow them to have a natural death.
The book that I have been reading and want to share is called "A Better Way of Dying" written by two sisters: Jeanne Fitzpatrick and Eileen Fitzpatrick. One is a doctor and one is a lawyer. I have acquired a few copies, so drop by if you would like to borrow one.
The front cover of the book quickly got my attention: "Why your Living Will is not enough". I often encourage my clients to have all their estate planning documents in order: their Will, their Power of Attorney (for finances), their Health Care Directive, and their Living Will. So why wouldn't these documents be enough? Let's read a bit of the book.
Here's an excerpt from the book A Better Way of Dying:
In my 30 years as an Emergency Room physician, I have watched many people die. I've learned from them that the modern death is often a chronic illness, spanning some five to ten years, in which a person slowly loses their mobility, their independence, their ability to perform basic activities of daily living, their intellect, and all ability to enjoy life. At some point in this decline, many of us would choose to say, "Enough suffering, just let me die."
Today, the act of letting nature take its course at the end of life - of allowing a natural death - is mostly unobtainable. When someone at the end of life takes a turn for the worse, their loved ones and caretakers will reflexively call 9-1-1 and seek medical care. Off to the emergency room they go, where I will once again treat their acute illness - their possible exit event - and prevent their natural death. While most people would prefer to die at home, 80 percent of the deaths in this North America occur in hospitals or nursing homes, as the technology that keeps us alive grows ever more complex.
Prior to the advent of antibiotics in 1933, elderly people tended to take to their beds, contract pneumonia or another infection within a year or two, and quietly pass away. Any doctor over the age of 50 will tell you that pneumonia used to be called "the old man's friend," as it brought an end to suffering and allowed a natural death to occur at the end of a person's span of years.
"Refusing antibiotics to treat pneumonia or other infections is one option available today in pursuit of a natural death. Other choices include discontinuing one's usual medications, foregoing trips to the emergency room for life-sustaining procedures, or refusing to receive artificial nutrition or hydration.
At the end of life, the body and mind naturally lose interest in food and fluids. When I reach the end of life, I want food and drink to be set by my bedside to take if I want it. My caretakers will know that I don't want to be reminded to eat or drink, and certainly not forced to - this may be my most powerful way to find a painless, peaceful natural death, particularly in the case of Alzheimer's Dementia.
"When a patient reaches his personally-defined milestones, his Healthcare Decision-Maker, doctor, and family can stop forcing food and liquids and allow him to die a natural, relatively painless death--without raising all the serious ethical concerns of physician-assisted death.
"The natural death movement has much to offer the current healthcare debate. There can be fates worse than death, and many of us know exactly how we do not want our lives to end--drooling on for years in a nursing home, lost to ourselves and our families.
I hope this brief excerpt of the book will get you thinking about your own end of life choices.
If you are interested in reading the book, I have a few copies that you can borrow. If you want the form "Contract for Compassionate Care", you can search for it on the Internet, or drop by my office: I have copies. If you want to have a chat about it, I'm very open to discussing it. When you are ready to have a family conference, I can help your family with the discussion.
On a personal note, there were a few incidences with my 94 year old father where I had to stop the health professionals from extending his dying. He was placed in a personal care home April 2014; he had been diagnosed with dementia and later on with bone cancer so we knew the end would not be good (could be painful). In October 2014, he was given "a nutritional beverage" with his meal, when I inquired with the nurse, they said because he is not eating much. I'm thinking: It's OK that he is not eating much! And I asked them stop giving it to him. He continued to eat and drink on his own (not much, but he normally ate something at every meal).
In late November, he had become unresponsive and the health care aid and nurse wanted to call an ambulance. I said: "no, we are not calling an ambulance; we want to ensure he is comfortable". So with the doctor's approval, they started the morphine under the skin (he had been taking orally). He did die naturally within about 18 hours.
I didn't know much at that time about "natural death", but I know now that is how my father died and that is what he wanted. I am comforted knowing he lived a good long life and had a "good death". And that is what I want too; hopefully in my 90s!
Anni Markmann is an independent financial planner and tax professional working, living, playing, and volunteering in our community. Contact her at 422-6631 or firstname.lastname@example.org or at 36 Dawson Road in Ste Anne.