End-of-Life Choice, Palliative Care and Counseling

Posts Taggedfeeding tube

A Precious Gift for Those You Love

by Terrell B. Vanaken
Daily Republic
January 10, 2013

During the holiday season, we often think of giving in terms of tangible, often costly items.

There is, however, an extremely valuable gift that we can offer at any time of year, and which costs virtually nothing. It’s something all of us can offer to our family and loved ones. It’s the knowledge and understanding of what we would want done at the time of a health emergency, when we cannot make decisions for ourselves.

An advance directive, when properly completed, is a legal document that stipulates who should make decisions at a time when an individual no longer can. It also allows you to specify your wishes for medical treatment and just how aggressive medical personnel should be with your care.

At a minimum, an advance directive should name the primary person you trust most to make major health care decisions about your welfare. This person is called your “agent” for health care decisions. You may also name an alternate in case your first choice is unavailable for any reason.

An advance directive can be completed by any adult and is made legal by the signature of a notary public or the signatures of two qualified witnesses. Of course, as we grow older, a directive becomes more and more important, since the incidence of health care emergencies increases as we age.

Many critically ill patients and families who I have met in the hospital have never sat down and actually talked about their wishes before such a tragedy occurs. We all tend to avoid these discussions, but after a stroke, a heart attack or life-threatening event, your loved one may not be able to talk at all or understand these issues. More

Dying of Cancer, Fritz Behr Refuses Radiation, Stops Eating, Has No Regrets

by Sanjay Talwani
Independent Record
November 27, 2012

A man on his deathbed smells delicious chocolate-chip cookies baking. He makes it out of bed and crawls downstairs to the kitchen, where he sees the cookies cooling on the table.

He reaches up for one, only to have his wife smack his hand away.

“Don’t touch them!” she says. “They’re for your funeral!”

That’s one of many jokes Fritz Behr has told Dr. Justin Thomas at the St. Peter’s Hospital Cancer Treatment Center lately. Behr visits the oncologist on Tuesdays, and has promised to bring two jokes with him at each appointment.

“It’s like ‘Tuesdays with Fritzie,’” Behr said, alluding to “Tuesdays With Morrie: An Old Man, a Young Man, and Life’s Greatest Lesson,” a 1997 book about a young man’s visits with his dying former college professor.

Behr, 79, has a big repertoire of jokes and also has stage four cancer. A tumor was removed from the back of his tongue about a year ago and he refused follow-up radiation therapy.

About 36 days ago, he decided not to eat, which he could do only with great difficulty anyway.

Now he spends his days at home, with plenty of visitors. He said he feels no hunger or pain, although he smells food and sometimes dreams of it.

“I got no regrets,” he said. “I’m as happy as a clam.” More

End of the Line in the ICU

by Kristen McConnell
The Brooklyn Rail
November 16, 2012

Last year I graduated from nursing school and began working in a specialized intensive care unit in a large academic hospital. During an orientation class a nurse who has worked on the unit for six years gave a presentation on the various kinds of strokes. Noting the difference between supratentorial and infratentorial strokes—the former being more survivable and the latter having a more severe effect on the body’s basic functions such as breathing—she said that if she were going to have a stroke, she knew which type she would prefer: “I would want to have an infratentorial stroke. Because I don’t even want to make it to the hospital.”

She wasn’t kidding, and after a couple months of work, I understood why. I also understood the nurses who voice their advocacy of natural death—and their fear of ending up like some of our patients—in regular discussions of plans for DNRtattoos. For example: “I am going to tattoo DO NOT RESUSCITATE across my chest. No, across my face, because they won’t take my gown off. I am going to tattoo DO NOT INTUBATE above my lip.”

Another nurse says that instead of DNR, she’s going to be DNA, Do Not Admit. We know that such plainly stated wishes would never be honored. Medical personnel are bound by legal documents and orders, and the DNR tattoo is mostly a very dark joke. But the oldest nurse on my unit has instructed her children never to call 911 for her, and readily discusses her suicide pact with her husband. You will not find a group less in favor of automatically aggressive, invasive medical care than intensive care nurses, because we see the pointless suffering it often causes in patients and families. Intensive care is at best a temporary detour during which a patient’s instability is monitored, analyzed, and corrected, but it is at worst a high tech torture chamber, a taste of hell during a person’s last days on earth.  More

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

Consider End-of-Life Options Carefully

By Mary Steiner
Honolulu Star Advertiser
September 23, 2012

Our hearts go out to Karen Okada, who lies dying while her family and the
lawyers argue over her body.

This 95-year-old woman expressed in her 1998 written “living will”
(advance directive) not to have her dying “artificially prolonged.”
We have all heard how important it is to create an advance directive if we
hope to make the journey to death in a manner consistent with our values.
Mrs. Okada’s experience makes clear this is not as easy as filling out a form
and filing it away.

Last month, Mrs. Okada suffered the latest in a series of medical crises that
began in December. Her doctors at The Queen’s Medical Center determined
she was beyond recovery and recommended removing her feeding tube.
A complicating factor is present, though. At the same time she documented
her wishes, Mrs. Okada also completed another equally important advanceplanning
document: She appointed her brother as her health care proxy to
make medical decisions if unable to do so herself. He insists the feeding tube
stay in place. More