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Ask Dr. Gott

Terminally-ill parent deserves peaceful end

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Posted: October 12, 2006 5:01 p.m.
Updated: October 23, 2006 4:18 p.m.
DEAR DR. GOTT: My sisters, brother and I have been caring for our 89-year-old mother for the past 15 years as she has slowly declined with dementia. The doctor has diagnosed her as having Alzheimer's disease. In January of 2005 our mother's condition worsened enough to warrant help from Hospice. We were told that Hospice helps care for patients for their last six months or so of life to keep them comfortable during the dying process. My sisters and I have been taking turns with our mother, staying at each home for three to six months at a time since January 2005. Currently, our mother is completely dependent. She cannot feed, bathe herself or even turn in the bed. She is able to eat soft foods (pureed) when spoon fed. She does not talk, yet does mumble intelligible words on occasion and she does still smile sometimes. Our mother has gone from about 120 pounds to 75 pounds over the past 17 months. She does not recognize anyone and often stares or has a frown on her face and keeps her hands stiffly by her body. She has had several pressure sores and skin irritations. I have provided specific details about her condition to convey her quality of life and medical status.
    The question is, should we continue to give her the regular medicines that she has taken for the past 30 years for high blood pressure, diabetes and heart disease? She currently receives the crushed pills in pureed food. We want to keep her comfortable and feel that medicine to help her relax and relieve arthritic pain are a must; however, we are not sure about the other medicines. Are the medicines prolonging the inevitable and making her more uncomfortable than she must already be? The Hospice nurses stated that usually their patients do not take any medicine toward the end of life other than those that will keep them comfortable. However, they have to get the OK from the patient's regular doctor to discontinue any medication.
    Several years ago, my mother made a statement that led me to believe she just wanted to die peacefully. It was one of the last things that our mother said. Her brain has obviously declined at a much more rapid rate than her heart. It seems that letting her heart decline naturally would be the humane thing to do. Do you think we should stop the regular medicines and let nature take its course or do you feel that they are also making her comfortable?
    DEAR READER: Let her die in peace.
    She is at the end of her rope, in a clearly terminal state. She needs, at this point, loving and caring for a terminal, fatal illness. I recommend that you stop all her medications, continuing only those that relieve pain and discomfort.
    Her "regular" medicines are probably not in this category. Your wish to be "humane" is appropriate. Sit down with her physician and nurses to develop a reasonable program for what time your mother has. Make sure that some family member has a health care proxy, a legal document — that varies from state to state — enabling family members to make health decisions for severely mentally impaired individuals.
    I applaud your reaching out for assistance in what is a highly emotionally-charged situation. You are doing what you can to resolve the difficulties inherent in this. Good luck and keep me posted.
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