life in the shadow of the sword of Damocles is one humans are not designed to endure.

[dolf]

what are your thoughts on end of life care?

 

[unregistered]

 

[Tathagata]

Depending on your outlook we are all under the sword of Damocles from day 1.
At any minute for any reason our life could end.

When talking about a situation like the man in the article I think he ( or she) should have the option to die with dignity.
Not in a public toilet.
At a place and time of his own choosing surrounded by his friends and family if he so chooses.

 

[dolf]

When talking about a situation like the man in the article I think he ( or she) should have the option to die with dignity.
Not in a public toilet.
At a place and time of his own choosing surrounded by his friends and family if he so chooses.

there is no choice for that option. that was his point.

we keep people alive till the last moment, either in agony or so pumped full of drugs that they can't even recognise their families. at that point they're incontinent, having people in to change their diapers and wipe their arses four times a day, parched because they can no longer swallow and their arteries have collapsed.

if you'd ever done palliative care, you'd know what the author and the man meant. it's all too often a barbaric thing to keep a person alive just so that they can suffer another day and you can pat yourself on the back for playing god.

it is not like in the movies.

 

[doowdniw]

I think everyone should have it as they need it. In my observation, old people tend to die as they lived. If they were close to friends and family during their life, then those friends and family tend to provide comfort and support as the end draws near.

It is a shame that "John" had to die in a public toilet, but then again, he was the one who chose the venue. Was he homeless? Did he have any friends or family? There is much this article leaves out, not the least of which is why anyone would attempt to resuscitate a corpse with obvious signs of rigor.

 

[oggbashan]

One of my family works in a hospice. They try to discuss with the patient and their family what should or should not be done. They strive to extend life with dignity and hope that the family can be brought to accept that there comes a time when invasive and aggressive life support is pointless.

One of my wife's very elderly relations had a massive stroke last weekend. Her immediate relations' instinctive reaction was 'Do everything!' but the doctors persuaded them that if they did, the quality of life would be very poor or dreadful.

For example if they had to do CPR it would probably break her whole rib cage and cause severe pain, yet the remaining brain activity was minimal.

The lady passed away within half a day without regaining consciousness.

 

[doowdniw]

Do people in the UK not have the ability to execute a "Directive to Physicians" or what is known as a "Living Will"? Can the patient or legal guardian not execute a DNR (Do Not Resuscitate)?

 

[oggbashan]

Do people in the UK not have the ability to execute a "Directive to Physicians" or what is known as a "Living Will"?

Yes, but it is the next of kin who has to agree if the patient becomes incapable of communicating their wishes.

A Living Will is only useful IF the next of kin has been warned that it exists.

 

[doowdniw]

Yes, but it is the next of kin who has to agree if the patient becomes incapable of communicating their wishes.

A Living Will is only useful IF the next of kin has been warned that it exists.

I always encouraged clients to give a copy directly to their attending physician and to make their wishes clearly know to their family members. Whether or not a Directive exists is one of the first questions asked by hospital admissions staff over here.

Granted, Directives as well as testamentary Wills are useless if nobody knows of their existence.

 

[snugglestruggle]

How we die is atleast as important as how we live or so I think. So I would not want to go to a hospice, I would chose my own time and place if that was the situation.

I would have it said of me that I lived well and died better, assuming there are still people left capable of understanding what that means.

 

[DesEsseintes]

What is more, although of course the moral argument for allowing individuals to make a rational choice is the key one, there is a huge economic argument too. 80% of NHS costs occur in the last three years of life, disproportionately with very old, very sick people. We spend thousands of pounds per week per patient keeping alive some advanced cancer patients for a few weeks longer.

Of course the relatives will want such people alive for longer. But relatives of a murder victim will often want the death penalty for the perpetrator - it does not follow that they are right, since they will be in the midst of strong emotions.

I do not see an argument against allowing patients, in their own time and provided they are given every opportunity to reverse their decision, to have assisted suicide as an option. As the article says, we do not question it in the case of animals, but somehow it is seen as immoral when it comes to human beings.

 

[dolf]

I think everyone should have it as they need it. In my observation, old people tend to die as they lived. If they were close to friends and family during their life, then those friends and family tend to provide comfort and support as the end draws near.

It is a shame that "John" had to die in a public toilet, but then again, he was the one who chose the venue. Was he homeless? Did he have any friends or family? There is much this article leaves out, not the least of which is why anyone would attempt to resuscitate a corpse with obvious signs of rigor.

it explains his choice of venue. he didn't want family/friends/carers finding him dead or, worse, near dead and then trying to 'save' him.

I'll wager I have a bit more experience than you when I say that the first part of your post is judgemental hogwash. lots of my clients simply outlived friends and family, or have families unable to help for various reasons. once you're all but housebound your ability to maintain relationships is significantly diminished. some of the most wonderful people I've ever met have spent the last years of their lives lonely.

Do people in the UK not have the ability to execute a "Directive to Physicians" or what is known as a "Living Will"? Can the patient or legal guardian not execute a DNR (Do Not Resuscitate)?

a dnr doesn't stop them bullying people into a drawn out death. it only stops them bringing people back from it.

 

[MrRandyWatson]

My wife and I were faced with caring for her deathly ill mom at this time last year. She was sick with a rare complication of kidney disease called calciphylaxis (Google images at your own risk - this is a bitch of a disease. It's as bad as cancer without the armies of researchers trying to cure it.)

From September 2013 until mid-February last year, we thought we were going to beat this. We had no idea it was a death sentence - and the doctors didn't seem to understand that either (and if they did, no one told us.) So for that length of time, we were about recovery. We had heard she could go back to her old self in 12-15 months, in time to see me graduate from law school. Then by the time she went into the hospital for the final time on February 11, 2014, it was down to "she'll be homebound and unable to work, and maybe on occasion she'll be able to go out to dinner with you guys." Forget the things she loved - traveling, church, shopping - that was it. But to us, and to my wife and her mom, who are devout Catholics, that's good enough.

Then the doctors hit us with a new reality - the best she'll be able to hope for is long-term care for life. She won't get to see me graduate. She won't be able to interact with her grandkids, assuming my wife and I ever had children (we still don't have them and won't for some time, most likely.) The thought of ever coming home, even for an afternoon, was pretty far out of reach. And even in this scenario, nothing is guaranteed. She could still die.

So we made the decision to put her in Hospice and discontinue care. (We live in Ohio and there's no such thing as assisted suicide, and even then, my MIL would have been totally opposed. So this was the closest thing we had.) She lasted just under two weeks - in a very diminished mental state. Finally, she was transferred to a hospice facility over the second weekend in March, and she passed away in the middle of the night going into Monday morning.

The idea of fighting like hell to save the saveable is what brings out the best in people. The idea of fighting like hell to save the unsaveable is utterly insane.

 

[Fata Morgana]

I think everyone should have it as they need it. In my observation, old people tend to die as they lived. If they were close to friends and family during their life, then those friends and family tend to provide comfort and support as the end draws near.

It is a shame that "John" had to die in a public toilet, but then again, he was the one who chose the venue. Was he homeless? Did he have any friends or family? There is much this article leaves out, not the least of which is why anyone would attempt to resuscitate a corpse with obvious signs of rigor.

If only your first paragraph were true.

When my dad had the last three years of his life in a very good nursing home I spent a lot of time there and there were rarely visitors for many. Old people are often forgotten. They've outlived their usefulness or in a lot of cases with their family, can no longer be a money source. Unfortunately in the UK it sometimes appears that the NHS feels the same.

 

[rimmy]

there is no choice for that option. that was his point.

we keep people alive till the last moment, either in agony or so pumped full of drugs that they can't even recognise their families. at that point they're incontinent, having people in to change their diapers and wipe their arses four times a day, parched because they can no longer swallow and their arteries have collapsed.

if you'd ever done palliative care, you'd know what the author and the man meant. it's all too often a barbaric thing to keep a person alive just so that they can suffer another day and you can pat yourself on the back for playing god.

it is not like in the movies.

Back in my youth when I did a lot more volunteer work than I do now I volunteered at a hospital and they asked me if I wanted to help out in the palliative unit. I said yes and lasted less than 1 day. It broke my heart to see people in that state.

We, as a society, place not enough emphasis on quality of life. My mom had a stroke 2 years ago and she should be in an assisted facility at this point due to a litany of issues but my brother, father and I decided not to because we know what those places are like and can't bring ourselves to put her there.

 

[Lancecastor]

There's big money in eldercare right now, and will be for the next 40 years until the Boomers all die off.

Seems to me someone ought to be able to create a chain or franchise model that makes money while also giving people a decent place to live.

 

[rimmy]

If only your first paragraph were true.

When my dad had the last three years of his life in a very good nursing home I spent a lot of time there and there were rarely visitors for many. Old people are often forgotten. They've outlived their usefulness or in a lot of cases with their family, can no longer be a money source. Unfortunately in the UK it sometimes appears that the NHS feels the same.

Sad but true.

When rimmy jr was born he spent his first two months in an incubator in the NICU. We were there for at least 8 hours a day and were completely shocked at how many kids parents didn't visit. When I asked one of the nurses about it she said that some cultures think it's better not to get attached to a sick child until they're sure they will survive. I guess it's the same with old folks. I ended up volunteering to hold the sick infants so they would have some human contact. I don't think I left there a single time without tears in my eyes.

 

[Fata Morgana]

Sad but true.

When rimmy jr was born he spent his first two months in an incubator in the NICU. We were there for at least 8 hours a day and were completely shocked at how many kids parents didn't visit. When I asked one of the nurses about it she said that some cultures think it's better not to get attached to a sick child until they're sure they will survive. I guess it's the same with old folks. I ended up volunteering to hold the sick infants so they would have some human contact. I don't think I left there a single time without tears in my eyes.

Wow. I'm genuinely shocked at that. I thought they'd be there all the time.

 

[MrRandyWatson]

Sad but true.

When rimmy jr was born he spent his first two months in an incubator in the NICU. We were there for at least 8 hours a day and were completely shocked at how many kids parents didn't visit. When I asked one of the nurses about it she said that some cultures think it's better not to get attached to a sick child until they're sure they will survive. I guess it's the same with old folks. I ended up volunteering to hold the sick infants so they would have some human contact. I don't think I left there a single time without tears in my eyes.

Amen. And if people rarely visit their fucking newborns, you can imagine how hard it is to get people into the CCU/ICU. I think in the entire time we were visiting MIL in the CCU and ICU when she was sick, there were maybe three or four families there besides ours - and this poor old man who never got a single visitor. It's almost as depressing as your own loved one's situation.

 

[dolf]

The idea of fighting like hell to save the saveable is what brings out the best in people. The idea of fighting like hell to save the unsaveable is utterly insane.

i googled. that poor lady! but she was blessed to have a family who chose the option that was genuinely in her best interest.

and, of course, you are right. it is utterly insane, but they still try.

Back in my youth when I did a lot more volunteer work than I do now I volunteered at a hospital and they asked me if I wanted to help out in the palliative unit. I said yes and lasted less than 1 day. It broke my heart to see people in that state.

We, as a society, place not enough emphasis on quality of life. My mom had a stroke 2 years ago and she should be in an assisted facility at this point due to a litany of issues but my brother, father and I decided not to because we know what those places are like and can't bring ourselves to put her there.

good for you. a lot of families try to push their elders into residential care, which can sometimes be a great thing but all too often isn't. i think it's because it makes them feel better about not helping, they can pretend s/he's in the best place. but most people just want to be in their own home, surrounded by the proof of their life.

 

[oggbashan]

All the UK hospices I am aware of are charitable (non-profit) organisations. They are very unlike nursing homes or residential care.

Those in hospices seem to be very well treated and cared for. Admission to a hospice is an acceptance that the end is not far off, and needs to be faced. The staff try to make the patient and family as relaxed about death as they can.

Unlike hospitals and nursing homes, hospice staff have time to be carers.

 

[rimmy]

Wow. I'm genuinely shocked at that. I thought they'd be there all the time.

We were stunned as well. They would have me take off my shirt and 'kangaroo' the newborn so they could feel my body heat. The nurses couldn't do it because they were so busy. That and the taking off their shirts thing. The only down side was when one of the little tykes would grab a handful of chest hair.

Amen. And if people rarely visit their fucking newborns, you can imagine how hard it is to get people into the CCU/ICU. I think in the entire time we were visiting MIL in the CCU and ICU when she was sick, there were maybe three or four families there besides ours - and this poor old man who never got a single visitor. It's almost as depressing as your own loved one's situation.

Same thing happened when my wife's grandmother was in the ICU before she passed.

good for you. a lot of families try to push their elders into residential care, which can sometimes be a great thing but all too often isn't. i think it's because it makes them feel better about not helping, they can pretend s/he's in the best place. but most people just want to be in their own home, surrounded by the proof of their life.

Between my mom, my dad and myself we have over 70 years of social work experience so we know full well what those places are like. And even if they can offer you the best living conditions and programs there is nothing like having family there.

 

[Noor]

Do people in the UK not have the ability to execute a "Directive to Physicians" or what is known as a "Living Will"? Can the patient or legal guardian not execute a DNR (Do Not Resuscitate)?

Do you know how many times that is ignored by family and medical personnel?

One of my family members with a terminal illness was resuscitated twice at a inpatient rehab facility.

The second time she ended up on complete life support with no brain activity. It took a court order with officers of the court at bedside to turn off her life support.

 

[Jennifer]

Do you know how many times that is ignored by family and medical personnel?

One of my family members with a terminal illness was resuscitated twice at a inpatient rehab facility.

The second time she ended up on complete life support with no brain activity. It took a court order with officers of the court at bedside to turn off her life support.

Yes, it's ignored all of the time. Physicians don't want to deal with hysterical families and and possible legal repercussions from them. Unless you have someone in your family who you trust as your advocate, most likely they will resuscitate you.

I very much believe in dignified, comfortable death.
I had a trauma patient once who jumped in front of a tractor trailer in order to kill herself. She was 22. They brought her to us in the OR as close to death as possible. We resuscitated her, but in order to save her we had to amputate both arms and one full leg and one half leg. She was left with one leg to the knee. Afterward, the doctors were really proud that they had managed to save her. We nurses were saddened and teary. She would wake up after trying to end her life with a long, virtually limbless life ahead of her.
I think about her all of the time.

 

[Noor]

Yes, it's ignored all of the time. Physicians don't want to deal with hysterical families and and possible legal repercussions from them. Unless you have someone in your family who you trust as your advocate, most likely they will resuscitate you.

I very much believe in dignified, comfortable death.
I had a trauma patient once who jumped in front of a tractor trailer in order to kill herself. She was 22. They brought her to us in the OR as close to death as possible. We resuscitated her, but in order to save her we had to amputate both arms and one full leg and one half leg. She was left with one leg to the knee. Afterward, the doctors were really proud that they had managed to save her. We nurses were saddened and teary. She would wake up after trying to end her life with a long, virtually limbless life ahead of her.
I think about her all of the time.

My family was totally behind the DNR they knew that and they ignored it.