I am a devout Christian and minister who has/had the responsibility for the care of my aging parents. Both Mom and Dad have spent the past several years in a nursing home, when it became unsafe to keep them in the home any longer. My dad passed in December, and my mother is in her 11th year of Alzheimer's. For the past four years she has been non-verbal and non-responsive. All her food is pureed and fed to her.
After my dad's passing I found my Mom's Living will which states that she does not want nutrition and hydration to "artificially" extend her life.
I am looking for counsel and advice. I have absolute certainty about her eternal destination, as I did with my dad. I did not/ do not fear the death of my parents, and I am at peace. I am uncertain about the morality of removing food and hydration from my mother, even though I suspect that it would be her wish.
update: Mom is not refusing food, but is hand fed specially prepared food as her swallowing is impaired.
Your comments and my further searches haves helped me to determine that “artificial” likely means a “feeding tube.” Her advanced directive would refuse both a feeding tube and any IVs for hydration.
So long as she still accepts hand fed food, I will ensure she has the opportunity to eat. If she refuses at any meal that is her choice, and I will instruct the caregivers to honor her disposition, and not overly encourage, or force her to eat.
Thanks for you help.
Grace & Peace
Tnekver62
Instead I made the decision that as long as she opened her mouth when I offered food I would continue to feed her and I know in my heart it was the right choice, if she had ever actually refused to open up and eat l would have honoured that.
If your Mom is not on Hospice you should make a call I think they would help you a lot.
If the person is not eating or drinking to give them food or fluids can cause more harm than good. If she is still eating the pureed food and drinking thickened fluids then continue on. Once she stops eating, she closes her mouth and no longer responds to the cues to open her mouth then you know it is her wish not to eat. You can try a few more times but don't force it.
In the last stages of life the body does not process food or fluids, it does not need the food or fluids. Since the body is not processing any food given may just sit in the stomach or gut and begin to decompose causing pain.
As a person is "Actively Dying" the body is doing 2 things it is keeping the heart beating and the the lungs breathing. Even those 2 tasks are difficult and you may see or hear that the breathing stops, heart bet becomes irregular or very slow.
Since the body does not use the food the person will not show signs of hunger. Fluids can be used with a swab to keep the mouth moist but to give someone something to drink may cause fluids to enter the lungs creating a bigger problem.
At this point keep your loved one comfortable, hold their hand, tell them that you love them. tell them that you will be alright, the family will be alright and give them permission to go.
When we start the dying process, our bodies start to shut down. First thing is we can't swallow. We no longer feel thirst or hunger. If they try to feed you, the body can no longer absorb nutrients so feeding doesn't help. My daughter is an RN in a rehab/NH facility. She told me to never allow a feeding tube for my 89 year old Mom with Dementia. Better to allow nature to takes its course. If a tube is put in, its hard to get it removed. Because the medical field feels you now are starving the person.
If you don't have hospice, have them come in and evaluate Mom. They can tell you if her time is coming. Really, do you want to prolong her life. She left a long time ago. Her soul is just waiting to be released. Its hanging by a thread. Hospice does not withhold if the person still wants to eat and drink. They just won't force feeding. Mom will be kept comfortable and pain free. Two weeks before Mom passed she closed her eyes. Could respond to people talking and she was taken to the common area during the day. Then, she couldn't swallow. Then she wouldn't get out of bed. I chose Hospice to come in. My daughter checked Mom out and agreed. She passed six days later. Miss her, yes the person she was, not what she had become. My Mom knew she would go to heaven so I am at peace.
My sister died of a brain tumor. She became unable to communicate with us in any way. Towards the end of her life she just did not want to eat anymore, so we let her stop eating. Then it became difficult to swallow and although she did not seem uncomfortable, the family tried to continue to give her liquids. Eventually, we settled for swabbing her mouth and using eye drops. We just wanted her to be comfortable.
In nature, animals that are dying do not eat or drink. I don't think they are in distress. I think the body knows what it needs to do. Have you consulted a palliative care group? They could probably help you with your decisions.
I'd show the living will to and speak with your mother's nursing home DON (Director of Nursing) and her doctor if she's to the point she mentioned in her directive. They can give you advice. Although you're a minister yourself, you need to talk with another minister or counselor to help guide and support you too.
Even though it's her wish and I know it would be a kindness to let her go, I can't imagine the impact on you. I can't imagine how traumatic it would be to actually implement it. It would be hard, but I'd do it.
As for morality, what's better FOR HER: implement her instructions and let her go or make her continue this way, possibly for years? Best wishes to you.
Thank you you for bringing up this hard topic, as it helped me think through my own plan.
When people refer to "artificial" feeding, they are usually talking about PEG feeding or tube feeding, which issues tend to arise when the swallowing reflex is impaired. They are not talking about a demented person being assisted to eat puréed food.
I can imagine how emotionally draining it must be to witness your mother's state for four years; and you now have the loss of your father to mourn too. Has anything else changed in your mother's condition?
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