End of Life Choices for 95 Year Old

[Methodi]

Last week he was taken to a doctor who told the care home to take him directly to the ER because his lungs were so congested with mucus that he was unable to lie down. The gurgling was very audible with each labored breath. Still, he was able to understand simple language and communication, from those he’s used to being around and could communicate back to us as he has for the past 10 years.

In the hospital his condition did not improve. His food was now minced and then pureed, liquids were thickened which he wouldn’t drink. The had him hooked up to an IV with fluid and antibiotics. If he ate too fast, he choked and even vomited his food during one meal. He was unable to get rid of all of the mucus which was way up in his trachea the doctor say and his “cough” was so weak and always exhale, exhale, exhale, exhale, exhale, exhale, exhale, exhale, exhale and not able to catch a breath to inhale always coming close to passing out. The nurses tried to stick flexible tubes down his throat and his nose but he’d panic and struggle because it hurt and terrified him. I kept giving him a little water from a plastic picnic spoon because the nurses and doctor refused to. He could eat ice cream and other soft foods but just teeny little bits off the end of the spoon. Still he choked and coughed to near passing out so they gave him morphine in low doses along with a steroid to take the swelling in his chest down and to help him breath and relax. It didn’t help.

They tried giving him breathing treatments with medicine in steam but he was terrified of that too and wanted it off. It would loosen the mucus a little but that caused him to cough in that weakend way and he was unable to bring the mucus up. We tried many times to suction it from his mouth but then he’d get confused and suck on the suction which made me throw up because it just grossed me out.

Finally when I was feeding him lunch one day he choked and coughed so badly that it went on for almost two hours with the nurses trying to suction him, I tried, and nothing worked until the raised the strength of the morphine to take down the swelling, relax him and to help him sleep. Whenever the aides came in to change and clean him and turn him, they would lay the bed down and he panic trying to call out that he couldn’t breath the entire time they had him lay flat and they would have to hurry to do this for him.

That day that the choking and coughing and hacking went on for hours my cousin and I and the doctor decided that we would raise the morphine so that he could stop struggling to breath, stop choking and trying to cough up mucus that refused to come out of his trachea. The doctor took him off all water by mouth and we decided to let him die because the only thing that would help him to stop choking and coughing was high doses of morphine whenever the choking started. They closed down his fluid IV and he went to sleep until he died.

I asked the doctor first if we did not do this, would he die choking and she said that he in all likelyhood would.

Your opinions please. Did we euthanise him or should be have let him choke to death naturally?

We all must eventually pass away, Your Uncle lived a long life with tremendous suffering, I believe it`s a Blessing that he was taken home to God, I think he was very tired. God Rest His Soul, You are to be commended for being there for him up until the end

 

[Br.Rich_SFO]

You are being WAY too hard on yourself. You made the correct decision, in terms of removing extraordinary care. The onus was on the hospital and medical people if there was anything inappropriate done. In the end, it is all a matter of opinion, anyway.

I am not sure I agree with Br. Rich, with all due respect, about the fluids. I have been in hospice for three years and oncology for several more. IV fluids during the dying process is not only painful, it worsens the respiratory symptoms. Most people who are conscious
during the end stage choose not to take many fluids, and especially no solids. This causes a dehydration that eases symptoms during what we call the active dying phase.
The difficulty comes in determining whether or not the patient is end stage or actively dying.

During active dying, the body organs begin to slowly shut down. Fluids at that time are not processed properly. It goes into the lungs and causes severe respiratory symptoms. It also goes into the tissues, and prolongs the whole process by reversing the circulatory shut down. I hope I am not being too graphic, here.

Your uncle, God rest his soul, was in dire straits regardless of what you did. He is with God, now. Do not beat yourself up about this situation, please. If it should ever happen again, seek out a good hospice, preferably a Catholic one, if they are still available, and
see what they say. If they seem too eager to end it without due process, keep looking.

I deal with this anytime someone is in the hospital. It is a situation in which, short of giving them something to stop their heart, there is no sure way to manage.

Be at peace.

I don’t disagree with you. I’m not speaking from a medical standpoint, but from a moral one. All I’m saying is if they are NOT complicating things IV fluids are NOT extraordinary means of treatment, but would be considered morally as an ordinary means of hydration for someone unable to drink fluids.

 

[HolySpirit08]

I’m still reading and re-reading, everyone and I cannot thank each and everyone one of you enough for your insight. I am learning so much. No matter what anyone says, I still feel in my gut that I jumped the gun and was too hasty to end my uncle’s suffering in this life.

He was still wanting to eat. He still had an appetite the last time he choked which was on lunch. Even after that two hour episode, he still wanted some Cheetos because he had only started his lunch when he started coughing and choking.

I just returned from his small funeral. The most beautiful thing happened. My cousin jumped into the hole and placed Uncle Eddie’s urn into the little concrete box enclosure with an orchid lei around it. He wanted to do that for Uncle Eddie - to be the last one who touched him - to close the door. Amen

 

[Spirithound]

That day that the choking and coughing and hacking went on for hours my cousin and I and the doctor decided that we would raise the morphine so that he could stop struggling to breath, stop choking and trying to cough up mucus that refused to come out of his trachea. The doctor took him off all water by mouth and we decided to let him die because the only thing that would help him to stop choking and coughing was high doses of morphine whenever the choking started. They closed down his fluid IV and he went to sleep until he died.

My cousin and mostly I spent hours and hours daily with our uncle in the hospital. The last night, I spent the night there after the priest gave him last rites.

Morally, we must employ “ordinary means”, meaning food and water, but only if the body is able to receive them. Extraordinary means do not have to be used. Painkillers may be used to ease a person’s pain, even if it hastens death (but I take that to mean "not causing death).

From your posts, it seems that your uncle was unable to receive fluids or food. Also, if my imagined timeline is correct, it seems that he didn’t die from dehydration, but from choking, or from something else.

My friend, please be at peace. Please speak to a priest, he can offer you some counselling.

My prayers are with you.

 

[St_Francis]

I just wanted to add a few things to what has been said here. The main thing is that your uncle died apparently the night the doctors stopped the fluids. That means he did not die of dehydration (since he had been receiving fluids before) but from his condition.

Euthanasia is taking an action (or not taking a necessary action) for the purpose of ending a life. In the case of Terry Schiavo, she would not have died had they continued to give her nutrition and hydration, which her body was accepting. Because feeding and hydrating her were necessary actions *in her condition *(can only be withdrawn if they do no good or cause harm to the patient), this was euthanasia.

Extraordinary means of medical intervention can be refused or withdrawn at any time for causing a burden to the patient or others. So it is actually legitimate to “ration” health care if done by those who are paying for or providing it, if the rationing is done in an otherwise moral way.

With the use of painkilling drugs, others have said that using the amount to properly control the pain or symptoms is actually morally necessary, even if this level hastens death. In your case, someone seems to have misunderstood your statement that they were increasing the morphine to reduce your uncle’s struggle to breathe to think that you meant that they were trying to reduce your uncle’s breathing rather than his struggle.

It would seem from everything that you have described that everything was in order. It seems that more aggressive treatment would only have delayed your uncle’s death, and made him suffer for that much longer. And your uncle received the Last Rite, which is in itself a wonderful thing! I am sure if the priest had thought anything was wrong that he would have asked about it, so I don’t think that that is an issue.

 

[HolySpirit08]

Thank you, “St. Francis”. If I am correct, the IV hydration was removed so that my uncle’s kidneys would shut down and he would go to sleep peacefully, pain free and die. If the IVfluids were continued, he may still be alive and struggling. My main purpose for the decisions that I made were indeed to end his life and his struggle. I did not want him to return to the care home where he did not receive the care that he needed. They also wanted to insert a feeding tube because my uncle often choked on his food. He suffered from dysphasia I think it’s called and could not tell us what was wrong. I didn’t even know about dysphasia until after he died and I came home and looked it up and read and read and read on the internet. At the care home and even in the hospital, no one explained that he had it or how to feed him - the doctor didn’t even tell the aides.

Too, the aides would come into his room every two hours throughout the night to clean him (he was incontinent) and they had to lay his bed flat in order to do that and he would be panicing and crying out because he couldn’t breath the entire time they would be cleaning him. I felt like that was enough already.

What was he being kept alive for? Why were they continuously poking his fingers to check his blood sugar and injecting him with insullin in his stomach when his sugar count was only high in the hospital? I asked the doctor to stop that. They were making him suffer unnecessarily. It was ridiculous. She (the doc) agreed.

His living will stated that he did not want to be hooked up to tubes and machines to prolong his life in a hospital bed. He was more able than Teri Shaivo to communicate and a pacemaker was making his heart pump. So if it was wrong to remove Teri Shaivo from life support, I think perhaps it was more wrong of me to not keep my uncle on it and other means of keeping him alive against his will. This is from a moral standpoint, of course.

I WOULD LOVE TO HEAR DIFFERENTLY FROM ANYONE because of course I am very stressed about my decision. I always think is black and white terms so I feel that I did wrong. I think I was too hasty. I just am not sure.

I am calling a priest today (again) because I did not receive a response over the weekend. I need to be forgiven because in my emotional, exhausted and depressed state, I did not once call on God for guidance. All I prayed for was that God take him. I feel like I did the wrong thing.

God bless.