End-of-Life Choice, Palliative Care and Counseling

unwanted treatment

The Cost of Dying: Simple Act of Feeding Poses Painful Choices

by Lisa M. Krieger
The Oakland Tribune
November 2, 2012

A small plastic tube is all that stands between survival and starvation.

The benefits of a feeding tube — helping elders who have forgotten how to eat — seem so obvious that it is used on one-third of demented nursing home residents, contributing to a growing device market worth $1.64 billion annually.

Except it does little to help. And it can hurt.

Decades after the tube achieved widespread use for people with irreversible dementia, some families are beginning to say no to them, as emerging research shows that artificial feeding prolongs, complicates and isolates dying.

The tale of the feeding tube, known as percutaneous endoscopic gastrostomy (PEG), is the latest installment of “Cost of Dying,” a series exploring how our technological ability to stave off death creates dilemmas unimaginable decades ago, when we died younger and more quickly.

Food is how we comfort those we love; when all other forms of communication have vanished, feeding remains a final act of devotion. So the easy availability of feeding tubes forces a wrenching choice upon families: Do we say yes, condemning a loved one to dependency on a small plastic tube in their stomach? Or do we say no, consenting to their death?

Tubes are useful as a nutritional tool for patients struggling with a critical illness, such as Lou Gehrig’s disease, or recovering from stroke, cancer or anorexia.

But if no turnaround is in sight — particularly in elders with progressive neurological illness — they can be a dreadful mistake, medical researchers now say. More

What Can We Learn From Eleanor Roosevelt’s Death?

by Barron H. Lerner
Huffington Post
October 23, 2012

Fifty years ago this November, when Eleanor Roosevelt’s doctor told her that her very debilitating disease was tuberculosis, and potentially curable, he expected her to be thrilled. But she instead uttered “I want to die” three times.

As the Affordable Health Care Act goes into effect, much attention is being paid to end-of-life care, and with good reason. Expenditures during patients’ last year of life are enormous — totaling roughly 25 percent of all Medicare costs – and often not very effective. Yet patients, health care providers and even insurers have a hard time saying no to such interventions.

Mrs. Roosevelt’s case vividly demonstrates how crucial it is for physicians to have frank end-of-life discussions about goals of care with patients and families — something that is still too often avoided. By challenging her physicians on this topic, she was, as usual, ahead of her time. More

Treating the Body, Mind and Soul

by Chris Conrad
Mail Tribune
October 21, 2012

Eighty-seven-year-old Dorella Johnson is tired.

She’s tired of suffering through multiple blood-draws every day to treat the chronic illnesses that have landed her in Providence Medford Medical Center. Her deep and fragile veins make it difficult to insert needles into her arms. Her arms are splotched with large purple and black bruises that stretch from her wrist all the way past her elbow.

She’s tired of spending her days in a hospital bed and not at the Medford home she and her late husband of 68 years, Roger Johnson, lived in for several years.

Her sister Ruth Wineteer came to Medford from her home in Eastern Oregon to be there when a decision was made on Johnson’s fate.

“She told me that she didn’t want any more shots, no more poking,” Wineteer said. “She just said, ‘No more. It hurts.’ ”

Johnson knows she has reached the end of her life and she wants to live out her final days in relative comfort, away from hospitals and doctors. More

Paralyzed Bank Manager Terminally Ill With Brain Cancer Fights for Her Right to Die

by Erica Pearson
New York Daily News
October 4, 2012

She is paralyzed from the neck down, tethered to breathing and feeding tubes — but Manhattan bank manager Grace Sung Eun Lee still managed to mouth four words Wednesday.

“I want to die.”

Doctors are trying to honor Lee’s wish, but her devout parents believe that removing the tubes is suicide — a sin that would condemn the 28-year-old to hell.

They’ve gone to court to keep the terminally ill brain-cancer patient on life support, turning a heartbreaking family tragedy into a right-to-die legal battle.

The case has put medical ethics and religion on a collision course, with lawyers arguing in two courtrooms while the patient at the center of the fight can do little more than blink her eyes. More